Bone Transplantation Through Fenestration Over The Femoral Head And Neck Combined With Implanation Of Peripheral Blood Stem Cells In The Treatment Of Osteonecrosis Of Femoral Head

Background: At present, the morbidity of osteonecrosis of the femoralhead is raised by various causes. The treatments varifies and is notconsummate. The insides have been concentrating on how to improve thetherapy.Objective: To study the curative effect of bone transplantation throughfenestration over the femoral head and neck combined with implanation ofperipheral blood stem cells in the treatment of osteonecrosis of femoral head.Methods: Among21patients with osteonecrosis of femoral heads(36hips),18patients were male and3patients female, age ranging from22to50years(average of33.6years). Unilateral head necrosis occurred in6hips. Andbilateral head necrosis occurred in30hips. The average medical history was1.4years ranging from8months to3years. According to the standard ofARCO staging,7hips were in the stage I, and29hips in the stage II, all thepatients were treated with bone transplantation through fenestration over thefemoral head and neck combined with implanation of peripheral blood stemcells from Jan.2009to Mar.2011.1、extracting PBSC:completed by thehematology department,5days before PBSC apheresis, doctors injectshypodermicly G-CSF2.5～5.0μg/（kg.d）into the patient for5consecutivedays,then they count and classify the numbers of white blood cell. Prolong thearousing period and increase the dose of G-CSF if the number of leukocyte isless than20×10~9/L.We dispose averagely5000ml PBSC at the rate of the cobespectra between50and55ml/min and separate mononuclear cell to keep thedensity up to1~3×10~11/L, making suspension in reverse.2、treatment of bonetransplantation through fenestration over the femoral head and neck combinedwith implanation of peripheral blood stem cells：we chisel the iliac bone and chop into small pieces(0.5×0.5×0.5cm~3)mixing togethe with PBSC,then holdit for30minites. We fenestrate the window about1.5×1.5cm~2dislodge thenecrosis bone tissue by osteotome and osteocuret,then put the mixed tussueinto the hole firmly and finally cove the window with a larger bone.3.postoperative management.paitents excersise hip on no-weight bearing underdoctor’s guide2days after operation. Patients can’t load on field with in3months.3months later, they can move under partial weight bearing withcrutches. The crutches can’t be discarded for1year. We prescribe them six toone years’ drugs which healthe wound. They pay a return visit on schedule.curative effect was analyzed according to clinical symptoms, the score of hipjoint function, the film of X ray and CT before and after operation. we own allof the patients preoperative and postoperative Harris scoring matching t testusing SPSS13.0statistical software for statistical analysisResults: The result of21hips in36patients are included, no shedding.the patients were all followed up for1to4years. were assessed and gradedaccording to the Harris hip score criteria based on the aspects of the degree ofpain, joint function, scope of activitie.29hip pain disappear, activities freely,curative effect is excellent.6hips’ condition relives. curative effect ismoderate.1hip aggravates and curative effct is poor. excellent and good rate is97.2%(35/36). X-rays, CTs show bone density, bone trabecular structureobviously improved than preoperation,29hips obtained excellent results.6hips got relief of clinical symptoms.1hip had no improvement. The rate ofexcellent and good was97.2%(35/36). The hips Harris score increasedaveragely from preoperative44.9±5.6to postoperative90.5±5.1(P<0.05).Conclusion: Bone transplantation through fenestration over the femoralhead and neck combined with implanation of peripheral blood stem cells canimprove the function of hips in the ARCO I and II stage and relieve the pain.The total arthroplasty can be delayed.