Treatment of avascular necrosis of femoral head by implanting a composite of autogenous bone marrow and noncelluar tissue engineered bone allograft with BMP / 中华骨科杂志

ABSTRACT

Objective To investigate the effect of treatment of avascular necrosis of femoral head in adolescence by implanting a composite of autogenous bone marrow, bone morphogenetic protein(BMP), and noncelluar tissue engineered bone allograft. Methods The BMP was partially purified from bovine cortical bone (bBMP) by Urist method. The bone allograft chips were mixed with bBMP and bone marrow. The composite was implanted into the necrotic area of the femoral head after core decompression, then partial deminerallized allograft fibula segments were inserted in the core decompression holes to support the necrotic area in preventing the collapse in 64 adolescent patients (78 hips). Results 55 cases (67 hips) were followed up for 3 months to 6 years(mean 44 months). 28 case(36 hips) in FicatⅠ,Ⅱ were followed up over 3 years, of whom there were no obvious pain and dysfunction in 18 cases(22 hips), high density new bone was shown in core decompression area in CT scanning, and no evidence of progressive necrosis. There was no worsening of the symptoms in 4 cases(6 hips) in Ficat Ⅰand Ⅱ, but the lesion progressed. In 6 cases (8 hips) in Ficat Ⅲ, there were no obvious pain and dysfunction in 2 cases, but 4 cases underwent total hip replacement because of persistent pain and progressive lesion. Conclusion The partial demineralized allograft fibula can provide direct mechanical support to prevent the necrotic femoral head from progress and collapse, autogenous bone marrow and BMP is able to promote new bone formation. The method can be used as an alternative for the treatment of osteonecrosis of femoral head at stage Ⅰ,Ⅱ.