谭伟源 安荣泽 齐新文 谢嘉清

[摘要] 目的 探讨经关节穿刺注射脂肪源性干细胞（ADSCs）修复兔激素性股骨头缺血性坏死的疗效。 方法 取成年新西兰大白兔颈背部脂肪组织提取脂肪源性干细胞培养并传代，36只新西兰大白兔通过马血清联合激素法建立激素性股骨头缺血性坏死模型，随机分为对照组、髓芯减压组及ADSCs组，每组各12只，并作骨密度检测。对照组不作干预处理，髓芯减压组股骨头钻孔减压，ADSCs组经关节穿刺注射ADSCs。分别于干预后4、8周每组取6只兔行骨密度检测及X线检查，处死后收集股骨头样本作大体观察，采用HE染色及PCR检测BMP-2 mRNA的表达，通过各组比较探讨经关节穿刺注射ADSCs修复激素性股骨头缺血性坏死的效果。 结果 干预后4、8周，三组骨密度呈下降趋势，但对照组下降幅度更大，与髓芯减压组、ADSCs组比较差异有统计学意义（P < 0.05），而髓芯减压组与ADSCs组相比较差异无统计学意义（P > 0.05）；大体观察、影像学及组织学表现，干预后4、8周与对照组比较，经关节穿刺注射ADSCs及髓芯减压均可延缓股骨头坏死的进展，对股骨头坏死起修复作用，ADSCs组优于髓芯减压组；干预后4、8周，ADSCs组及髓芯减压组BMP-2 mRNA的表达水平均高于对照组，差异有统计学意义（P < 0.05），而髓芯减压组与ADSCs比较差异无统计学意义（P > 0.05）。 结论 经关节穿刺注射ADSCs对兔激素性股骨头缺血性坏死有修復作用。

[关键词] 激素性股骨头缺血性坏死；脂肪源性干细胞；关节穿刺；修复

[中图分类号] R6874 [文献标识码] A [文章编号] 1673-7210（2018）03（a）-0175-06

Repair of rabbit steroid-induced avascular necrosis of femoral head by ADSCs injection through the joint puncture

TAN Weiyuan AN Rongze QI Xinwen XIE Jiaqing

Department of Orthopedics， the Fifth Affiliated Hospital of Zunyi Medical College， Guangdong Province， Zhuhai 519100， China

[Abstract] Objective To investigate the effect of adipose derived stem cells （ADSCs） injection through the joint puncture on the repair of steroid-induced avascular necrosis of femoral head in rabbits. Methods ADSCs were isolated and passaged from the neck adipose tissue of adult New Zealand white rabbits. Thirty-six New Zealand white rabbits were used to establish the model of steroid-induced avascular necrosis of femoral head by horse serum combined with hormone. These rabbits were randomly divided into control group， core decompression group and ADSCs group （12 rabbits in each group）， and all for bone density detection. Control group：no intervention； core decompression group： femoral head drilling decompression； ADSCs group：by intra-articular injection of ADSCs. At 4 weeks and 8 weeks after intervention， 6 rabbits in each group were examined with bone mineral density （BMD） and X-ray examination. After the death， their femur samples were collected for gross observation， HE staining and PCR were used for the measurement of BMP-2 mRNA. Through the comparison of each group to explore the effect of ADSCs repairing steroid-induced avascular necrosis of the femoral head by joint puncture injection. Results 4 weeks and 8 weeks after intervention three groups of BMD， but the control group decreased， compared with core decompression group and ADSCs group were statistically significant （P < 0.05）， but there was no significant difference between the core decompression group and the ADSCs group （P > 0.05）. General observation， imaging and histological findings at 4 weeks and 8 weeks after intervention， compared with the control group， ADSCs treatment by joint puncture injection and core decompression both can delay the progress of femoral head necrosis. There had a repair effect on femoral head necrosis， and the effects in ADSCs group were better than those in core decompression group； at 4 weeks and 8 weeks after intervention， the expression of BMP-2 mRNA in the ADSCs group and the core decompression group were both higher than those in the control group， the differences were statistically significant （P < 0.05）， while there was no significant difference between the core decompression group and the ADSCs group （P > 0.05）. Conclusion ADSCs injected through the joint puncture can repair the steroid induced avascular necrosis of the femoral head in rabbits.

[Key words] Avascular necrosis of the femoral head； Adipose-derived stem cells； Joint puncture； Repair

股骨头缺血性坏死（avascular necrosis of the femoral head，ANFH）是骨科全球性难治性疾病之一[1]，目前随着激素类药物的广泛应用，激素性股骨头缺血性坏死（steroid-induced avascular necrosis of the femoral head，SAFNH）发病率逐年上升，在我国已成为最常见的非创伤性股骨头坏死[2-3]。……