采用浓缩自体骨髓抽吸物移植的保髋手术治疗无症状股骨头坏死：术后6年临床及影像学结果的回顾性分析

Hip preserving surgery with concentrated autologous bone marrow aspirate transplantation for the treatment of asymptomatic osteonecrosis of the femoral head: retrospective review of clinical and radiological outcomes at 6 years postoperatively.

作者信息

Tomaru Yohei, Yoshioka Tomokazu, Sugaya Hisashi, Aoto Katsuya, Wada Hiroshi, Akaogi Hiroshi, Yamazaki Masashi, Mishima Hajime

机构信息

Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.

Division of Regenerative Medicine for Musculoskeletal System, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.

出版信息

BMC Musculoskelet Disord. 2017 Jul 6;18(1):292. doi: 10.1186/s12891-017-1652-8.

DOI:10.1186/s12891-017-1652-8

PMID:28683795

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5501539/

Abstract

BACKGROUND

We had previously established concentrated autologous bone marrow aspirate transplantation (CABMAT), a one-step, low-invasive, joint-preserving surgical technique for treating osteonecrosis of the femoral head (ONFH). The present study aimed to evaluate the effects of CABMAT as a hip preserving surgical approach, preventing femoral head collapse in asymptomatic ONFH.

METHODS

In total, 222 patients (341 hips) with ONFH were treated with CABMAT between April 2003 and March 2013. Based on magnetic resonance imaging, we determined that 119 of these patients had bilateral asymptomatic ONFH (238 hips), and 38 further patients had unilateral asymptomatic ONFH (38 hips). In this series, we retrospectively examined 31 hips in 31 patients with unilateral asymptomatic ONFH treated surgically between 2003 and 2012 and followed up for more than 2 years. Clinical and radiological evaluation were performed immediately before the procedure and at the final follow-up. The two-year follow-up rate among patients with unilateral ONFH was 82% (31/38). Therefore, the present study included 31 patients (19 males and 12 females), with a mean age and follow-up period of 40 and 5.8 years, respectively. Of the 31 asymptomatic hips, 5, 6, 10, and 10 had osteonecrosis of types A, B, C1, and C2, respectively. The diagnosis, classification, and staging of ONFH were based on the 2001 Japanese Orthopaedic Association (JOA) classification.

RESULTS

Secondary collapse of the femoral head was observed in 6/10 hips and 5/10 hips with osteonecrosis of types C1 and C2, respectively. Total hip arthroplasty was performed in 9.6% of patients (3/31 hips), at an average of 33 months after surgery. Clinical symptoms improved after surgery, and the secondary collapse rate at a mean of 5.8 years after CABMAT was lower than that reported in several previous studies on the natural course of asymptomatic ONFH.

CONCLUSIONS

Early diagnosis of ONFH (i.e., before femoral head collapse) and early intervention with CABMAT could improve the clinical outcome of corticosteroid and alcohol-induced ONFH.

摘要

背景

我们之前建立了浓缩自体骨髓抽吸物移植术（CABMAT），这是一种用于治疗股骨头坏死（ONFH）的一步式、低侵入性、保留关节的手术技术。本研究旨在评估CABMAT作为一种保留髋关节的手术方法在预防无症状ONFH患者股骨头塌陷方面的效果。

方法

2003年4月至2013年3月期间，共有222例ONFH患者（341髋）接受了CABMAT治疗。基于磁共振成像，我们确定其中119例患者患有双侧无症状ONFH（238髋），另有38例患者患有单侧无症状ONFH（38髋）。在本系列研究中，我们回顾性分析了2003年至2012年期间接受手术治疗的31例单侧无症状ONFH患者的31髋，并进行了超过2年的随访。在手术前和最终随访时进行了临床和影像学评估。单侧ONFH患者的两年随访率为82%（(31/38)）。因此，本研究纳入了31例患者（19例男性和12例女性），平均年龄和随访时间分别为40岁和5.8年。在这31例无症状髋关节中，分别有5例、6例、10例和10例患有A、B、C1和C2型骨坏死。ONFH的诊断、分类和分期基于2001年日本骨科协会（JOA）分类。