Mishima Hajime, Sugaya Hisashi, Yoshioka Tomokazu, Aoto Katsuya, Wada Hiroshi, Akaogi Hiroshi, Ochiai Naoyuki
Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
Eur J Orthop Surg Traumatol. 2016 Apr;26(3):293-8. doi: 10.1007/s00590-016-1752-4. Epub 2016 Feb 27.
Osteonecrosis of the femoral head (ONFH) is commonly treated with total hip arthroplasty; however, the disadvantages of this form of treatment, especially in young patients, include the need for revision arthroplasty. Here we describe a novel, combined approach to the treatment of ONFH based on autologous concentrated bone marrow grafting and low-intensity pulsed ultrasound (LIPUS). The 7 male and 7 female patients (mean age: 40 years; 22 hips) underwent autologous concentrated bone marrow grafting followed by 6 months of continuous LIPUS. The mean follow-up period was 26 months. We evaluated site-specific bacterial infection of the grafted bone marrow concentrate microbiologically and site-specific cancer by magnetic resonance imaging 24 months after grafting. All patients were assessed using the visual analogue scale (VAS) for pain and the Japanese Orthopedic Association (JOA) hip score. Clinical and plain radiographic evaluations were performed before grafting and at the most recent follow-up. Computed tomography (CT) scans were obtained before and 12 months after grafting. None of the grafted bone marrow concentrates were infected, and none of the patients developed a tumor at the treatment site. The VAS and JOA scores improved in all patients. Collapse progressed in 8 of the 22 hips, but none required total hip arthroplasty. The mean volume of new bone formation 12 months post-grafting as seen on CT was 1256 mm(3). New bone formation was observed in all patients. Our study demonstrates the safety and efficacy of autologous concentrated bone marrow grafting and LIPUS as a joint-preserving procedure for patients with ONFH.
股骨头坏死（ONFH）通常采用全髋关节置换术进行治疗；然而，这种治疗方式的缺点，尤其是在年轻患者中，包括需要进行翻修置换术。在此，我们描述一种基于自体浓缩骨髓移植和低强度脉冲超声（LIPUS）治疗ONFH的新型联合方法。7例男性和7例女性患者（平均年龄：40岁；22髋）接受了自体浓缩骨髓移植，随后连续6个月进行LIPUS治疗。平均随访期为26个月。我们在移植后24个月通过微生物学方法评估移植骨髓浓缩物的局部细菌感染情况，并通过磁共振成像评估局部癌症情况。所有患者均使用视觉模拟评分法（VAS）评估疼痛情况，并使用日本骨科协会（JOA）髋关节评分进行评估。在移植前和最近一次随访时进行临床和X线平片评估。在移植前和移植后12个月进行计算机断层扫描（CT）。所有移植的骨髓浓缩物均未发生感染，且所有患者在治疗部位均未发生肿瘤。所有患者的VAS和JOA评分均有所改善。22髋中有8髋出现塌陷进展，但均无需进行全髋关节置换术。CT显示移植后12个月新骨形成的平均体积为1256立方毫米。所有患者均观察到有新骨形成。我们的研究证明了自体浓缩骨髓移植和LIPUS作为ONFH患者保关节手术的安全性和有效性。
