Chotivichit Areesak, Korwutthikulrangsri Ekkapoj, Auewarakul Chirayu, Sarirasririd Sorarid
Department of Orthopedics Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2012 Sep;95 Suppl 9:S14-20.
Osteonecrosis of the femoral head is a deficiency of blood supply resulting in femoral head collapse and joint destruction. This usually found in young adults as the leading cause of hip arthroplasty. Core decompression has been reported to reduce the bone marrow pressure for treatment of stage I and II of disease. Later, addition of concentrated bone marrow injection was proposed and reported good result. The purpose of the present study was to report the result of core decompression and concentrated bone marrow injection.
Twelve patients with osteonecrosis of femoral head underwent a core decompression and concentrated autologous bone marrow injection. Data of age, sex, underlying disease, risk of osteonecrosis were collected. Patients were followed at 3 months, 6 months, 1 year and then yearly. Radiographic data were recorded.
Thirteen hips in 12 patients underwent the procedure. Two cases were excluded due to loss of follow-up. Mean age was 36.2 (12-56). One hip were in stage I, five in stage II and five in stage III. Risk factor included steroid usage in 6 hips and alcohol consumption in 3 hips. Underlying diseases were SLE (5), dermatitis (1), post-traumatic (1). Average nucleated cell from marrow was 91.58 x 10(6)/ml (+/- 55.9). CD34 was 17.25 x 10(6)/ml cells and percentage of recovery of mononuclear cell was 70.4%. Mean follow-up time was 3.6 years (range 1-7 years). All cases had good pain relief initially. At the last followup 8 hips (72%) had progression and 2 underwent surgery. No infection occurred. No adverse effect detected.
This report showed low success rate of core decompression with concentrated autologous bone marrow grafting. The effect of delayed progression is not clear. However, the procedure appeared to be safe without immediate complication.
股骨头坏死是一种血液供应不足导致股骨头塌陷和关节破坏的疾病。这种疾病常见于年轻人，是髋关节置换术的主要原因。据报道，髓芯减压可降低骨髓压力，用于治疗疾病的I期和II期。后来，有人提出在髓芯减压的基础上增加浓缩骨髓注射，并报告了良好的效果。本研究的目的是报告髓芯减压和浓缩骨髓注射的结果。
12例股骨头坏死患者接受了髓芯减压和自体浓缩骨髓注射。收集了年龄、性别、基础疾病、股骨头坏死风险等数据。患者在3个月、6个月、1年时进行随访，之后每年随访一次。记录影像学数据。
12例患者的13个髋关节接受了该手术。2例因失访被排除。平均年龄为36.2岁（12 - 56岁）。1个髋关节处于I期，5个处于II期，5个处于III期。危险因素包括6个髋关节使用类固醇和3个髋关节饮酒。基础疾病有系统性红斑狼疮（5例）、皮炎（1例）、创伤后（1例）。骨髓平均有核细胞数为91.58×10⁶/ml（±55.9）。CD34为17.25×10⁶/ml细胞，单核细胞回收率为70.4%。平均随访时间为3.6年（范围1 - 7年）。所有病例最初疼痛缓解良好。在最后一次随访时，8个髋关节（72%）病情进展，2个接受了手术。未发生感染。未检测到不良反应。
本报告显示髓芯减压联合自体浓缩骨髓移植的成功率较低。延迟病情进展的效果尚不清楚。然而，该手术似乎是安全的，没有即刻并发症。
