Department of Orthopaedic Surgery, Stanford University Medical Center Outpatient Center, Redwood City, CA; Department of Orthopaedic Surgery, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand.
Department of Orthopaedic Surgery, Stanford University Medical Center Outpatient Center, Redwood City, CA.
J Arthroplasty. 2021 Jun;36(6):1879-1886. doi: 10.1016/j.arth.2021.01.075. Epub 2021 Feb 2.
Core decompression is the most common procedure for early-stage osteonecrosis of the femoral head (ONFH). This study investigated outcomes of core decompression with/without bone marrow aspirate concentrate (BMAC), based on the Kerboul combined necrotic angles using magnetic resonance imaging.
We reviewed 66 patients (83 hips) with early ONFH, Association Research Circulation Osseous stages I-IIIa, who underwent core decompression alone (26 patients, 33 hips) or in combination with BMAC (40 patients, 50 hips). Survival rate and progressive collapse were analyzed using the Kaplan-Meier method, and conversion to total hip arthroplasty (THA) was evaluated. Subgroup analyses based on the modified Kerboul angle were performed: grade I (<200°), grade II (200°-249°), grade III (250°-299°), and grade IV (≥300°).
Mean follow-up was 36 ± 23 months. Femoral head collapse with BMAC (16 hips, 32%) was significantly lower than without BMAC (19 hips, 58%, P = .019). Conversion THA was significantly lower with BMAC (28%) than without (58%, P = .007). Survival rates among groups showed significant differences (P = .017). In grade I, 0/12 hips with BMAC collapsed while 3/9 (33%) without BMAC collapsed (P = .063); in grade II, 2/16 hips (12%) with BMAC collapsed while 7/13 (54%) without BMAC collapsed (P = .023). There was no significant difference in collapse with (64%) or without (82%) BMAC in grade III-IV hips (P = .256).
Core decompression with/without BMAC had a high failure rate, by increasing disease progression and the necessity for THA, for combined necrotic angles >250°. In our study, addition of BMAC had more reliable outcomes than isolated core decompression for precollapse ONFH if the combined necrotic angles were <250°.
核心减压术是治疗早期股骨头坏死（ONFH）最常用的方法。本研究通过磁共振成像（MRI）基于 Kerboul 联合坏死角，探讨了单纯核心减压术与核心减压术联合骨髓抽吸浓缩物（BMAC）治疗的疗效。
我们回顾了 66 例（83 髋）早期 ONFH（Association Research Circulation Osseous 分期 I-IIIa）患者，分别接受了单纯核心减压术（26 例，33 髋）或核心减压术联合 BMAC（40 例，50 髋）治疗。采用 Kaplan-Meier 法分析生存率和进展性塌陷，评估全髋关节置换术（THA）的转换。根据改良 Kerboul 角进行亚组分析：I 级（<200°），II 级（200°-249°），III 级（250°-299°）和 IV 级（≥300°）。
平均随访 36±23 个月。与无 BMAC 组（19 髋，58%）相比，BMAC 组（16 髋，32%）的股骨头塌陷发生率显著降低（P=0.019）。与无 BMAC 组（58%）相比，BMAC 组（28%）行 THA 的转化率显著降低（P=0.007）。各组的生存率差异有统计学意义（P=0.017）。在 I 级中，12%（1/8）的有 BMAC 组髋部发生塌陷，而 54%（5/9）的无 BMAC 组髋部发生塌陷（P=0.063）；在 II 级中，12%（2/16）的有 BMAC 组髋部发生塌陷，而 54%（7/13）的无 BMAC 组髋部发生塌陷（P=0.023）。III-IV 级髋部的 BMAC 组（64%）和无 BMAC 组（82%）的塌陷发生率差异无统计学意义（P=0.256）。
对于联合坏死角>250°的患者，核心减压术与核心减压术联合 BMAC 均具有较高的失败率，会增加疾病进展和行 THA 的必要性。在本研究中，如果联合坏死角<250°，与单纯核心减压术相比，核心减压术联合 BMAC 对早期 ONFH 具有更可靠的疗效。
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