核心减压和骨髓抽吸浓缩植骨治疗股骨头坏死。
Core Decompression and Bone Marrow Aspiration Concentrate Grafting for Osteonecrosis of the Femoral Head.
机构信息
Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota.
Department of Orthopaedic Surgery, George Washington University, Washington, District of Columbia.
出版信息
J Bone Joint Surg Am. 2022 Apr 6;104(Suppl 2):54-60. doi: 10.2106/JBJS.20.00527.
BACKGROUND
Core decompression (CD) with bone marrow aspiration concentrate (BMAC) is a technique that may improve outcomes in osteonecrosis of the femoral head (ONFH). The primary aim of this study was to evaluate the radiographic progression free survival (PFS) of CD augmented with BMAC. Secondary aims were to determine the survivorship with conversion (CFS) to total hip arthroplasty (THA) as an endpoint, determine prognostic factors, and characterize the cellular quality of the BMAC.
METHODS
A retrospective cohort study of 61 femoral heads (40 patients) was performed. Patient demographics, comorbidities, BMI, smoking status, etiology, location and extent of ONFH were recorded. The primary endpoint was radiographic progression of ONFH and secondarily, conversion to THA. Additional aims were to determine predictive factors for progression and report the cellular characteristics of the BMAC. Data obtained were compared to the results of a prior randomized controlled trial comparing CD alone versus CD with polymethylmethacrylate cement (PMMA) augmentation.
RESULTS
Radiographic PFS of CD with BMAC at 2 and 5 years was 78.3% and 53.3%, respectively. The risk of progression was lower in the CD with BMAC group compared to CD alone (HR0.45, p = 0.03), however this difference no longer remained statistically significant on multivariate analysis. Conversion to total hip arthroplasty free survival (CFS) of CD with BMAC at both 2 and 5 years was 72.1% and 54.6%, respectively with no differences compared to the control groups (CD alone, CD and PMMA). The predictive factors for progression were obesity (BMI ≥ 30) and the extent of the disease as quantified by either percentage involvement, necrotic index or modified necrotic index.
CONCLUSIONS
No differences in PFS or CFS between CD with BMAC compared to CD alone or CD with PMMA were identified. Independent statistically significant predictors of progression-free survival or conversion to THA are BMI ≥ 30 and the extent of ONFH. Further research with an adequately powered randomized controlled trial is needed.
LEVEL OF EVIDENCE
背景
核心减压（CD）联合骨髓抽吸浓缩物（BMAC）是一种可能改善股骨头坏死（ONFH）患者预后的技术。本研究的主要目的是评估 CD 联合 BMAC 治疗的影像学无进展生存率（PFS）。次要目的是确定以转换（CFS）为终点的全髋关节置换术（THA）的生存率，确定预测因素，并描述 BMAC 的细胞质量。
方法
对 61 个股骨头（40 例患者）进行回顾性队列研究。记录患者的人口统计学、合并症、BMI、吸烟状况、病因、ONFH 的位置和范围。主要终点是 ONFH 的影像学进展，其次是转换为 THA。其他目的是确定进展的预测因素，并报告 BMAC 的细胞特征。与之前的一项比较单独 CD 与 CD 联合聚甲基丙烯酸甲酯水泥（PMMA）增强的随机对照试验的结果进行比较。
结果
CD 联合 BMAC 的影像学 PFS 在 2 年和 5 年时分别为 78.3%和 53.3%。与单独 CD 相比，CD 联合 BMAC 组的进展风险较低（HR0.45，p = 0.03），但在多变量分析中这一差异不再具有统计学意义。CD 联合 BMAC 的 2 年和 5 年时转换为 THA 的无进展生存率（CFS）分别为 72.1%和 54.6%，与对照组（单独 CD、CD 和 PMMA）相比无差异。进展的预测因素是肥胖（BMI≥30）和疾病的严重程度，分别通过受累百分比、坏死指数或改良坏死指数来量化。
结论
与单独 CD 或 CD 联合 PMMA 相比，CD 联合 BMAC 在 PFS 或 CFS 方面没有差异。无进展生存率或转换为 THA 的独立有统计学意义的预测因素是 BMI≥30 和 ONFH 的严重程度。需要进一步进行具有足够效力的随机对照试验研究。
证据水平
3 级。
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