Tomaru Yohei, Yoshioka Tomokazu, Nanakamura Junichi, Sugaya Hisashi, Hagiwara Shigeo, Nawata Kento, Ohtori Seiji, Yamazaki Masashi, Mishima Hajime
Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan.
Division of Regenerative Medicine for Musculoskeletal System, Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan.
J Rural Med. 2021 Jan;16(1):1-7. doi: 10.2185/jrm.2020-033. Epub 2021 Jan 5.
To compare the outcomes of steroid-associated osteonecrosis of the femoral head in patients with systemic lupus erythematosus who underwent conservative treatment and concentrated autologous bone marrow aspirate transplantation Osteonecrosis of the femoral head was classified according to the Japanese Investigation Committee system. Concentrated autologous bone marrow aspirate transplantation was performed by aspirating the bone marrow from both iliac crests and then transplanting it to the necrotic area after the core decompression. Patients with >2-year follow-up after the concentrated autologous bone marrow aspirate transplantation in our institution (Group I) and those with >2-year follow-up after the first hospital visit in a cooperative institution (Group II) were included in this study. After a randomized matching based on age, sex, type, stage, and etiology, the collapse rate in pre-collapsed stages and total hip arthroplasty conversion rate in all stages were compared between the two groups. After the matching adjustment, 33 pairs of hips were included. Preoperatively, 1, 2, 16, and 14 hips were classified as types A, B, C1, and C2, respectively, and 15, 13, 2, and 3 hips were classified as stages 1, 2, 3A, and 3B, respectively. The collapse rates in the pre-collapsed stages were 68% and 39% in Groups I and II, respectively. Total hip arthroplasty conversion rates were 33% and 45% in Groups I and II, respectively. However, Group I had significantly higher and lower conversion rates in stages 1 and 3, respectively (both <0.05). Conservative treatment may be preferable in stage 1 hips. In addition, concentrated autologous bone marrow aspirate transplantation may prevent further collapse in stage 3.
比较接受保守治疗和浓缩自体骨髓抽吸物移植的系统性红斑狼疮患者股骨头类固醇相关骨坏死的治疗结果。根据日本调查委员会系统对股骨头坏死进行分类。通过从双侧髂嵴抽吸骨髓，然后在髓芯减压后将其移植到坏死区域来进行浓缩自体骨髓抽吸物移植。纳入在本机构接受浓缩自体骨髓抽吸物移植后随访超过2年的患者（第一组）以及在合作机构首次就诊后随访超过2年的患者（第二组）。在根据年龄、性别、类型、阶段和病因进行随机匹配后，比较两组在塌陷前期的塌陷率和所有阶段的全髋关节置换转化率。匹配调整后，纳入33对髋关节。术前，分别有1、2、16和14髋被分类为A、B、C1和C2型，分别有15、13、2和3髋被分类为1、2、3A和3B期。第一组和第二组在塌陷前期的塌陷率分别为68%和39%。第一组和第二组的全髋关节置换转化率分别为33%和45%。然而，第一组在1期和3期的转化率分别显著更高和更低（均P<0.05）。对于1期髋关节，保守治疗可能更可取。此外，浓缩自体骨髓抽吸物移植可能预防3期的进一步塌陷。
