Tomaru Yohei, Yoshioka Tomokazu, Sugaya Hisashi, Kumagai Hiroshi, Aoto Katsuya, Wada Hiroshi, Akaogi Hiroshi, Yamazaki Masashi, Mishima Hajime
Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, JPN.
Department of Orthopedic Surgery, Chiba Child and Adult Orthopedic Clinic, Chiba, JPN.
Cureus. 2022 May 2;14(5):e24658. doi: 10.7759/cureus.24658. eCollection 2022 May.
Purpose The purpose is to compare the therapeutic efficacy of concentrated autologous bone marrow aspirate transplantation (CABMAT) with that of observation alone for osteonecrosis of the femoral head (ONFH). Methods This single-center study included patients with idiopathic ONFH that were either treated with CABMAT (CABMAT group) or managed through observation alone (observation group) over a >2-year follow-up period. The Japanese Investigation Committee classification was used to diagnose and classify ONFH. The collapse rates for stages 1 and 2 ONFH (i.e., pre-collapse stages) and the THA conversion rates were compared between the CABMAT and observation groups. Results The CABMAT and observation groups comprised 232 (mean follow-up: 8.2 years) and 106 (mean follow-up: 6.0 years) patients, respectively. No significant intergroup differences were noted in the stages, types, and associated factors of ONFH. The collapse rates for pre-collapse stages in the CABMAT and observation groups were 67.1% and 65.3%, respectively. For stage 1, the collapse rates were significantly lower in the observation group than in the CABMAT group (p<0.05). The overall THA conversion rates in the CABMAT and observation groups were 24.3% and 41.5%, respectively (p<0.0001). For ONFH of stages 3A and 3B (collapse stages), the THA conversion rates were significantly lower in the CABMAT group (p<0.05). Conclusion Collapse rates were significantly higher for stage 1 ONFH; for collapse stages, the THA conversion rates were significantly lower in the CABMAT group than in the observation group. Therefore, observation and CABMAT are recommended for ONFH of stage 1 and for ONFH of higher stages, respectively.
目的 目的是比较浓缩自体骨髓抽吸物移植（CABMAT）与单纯观察治疗股骨头坏死（ONFH）的疗效。方法 这项单中心研究纳入了特发性ONFH患者，在超过2年的随访期内，这些患者要么接受CABMAT治疗（CABMAT组），要么仅通过观察进行处理（观察组）。采用日本调查委员会分类法对ONFH进行诊断和分类。比较CABMAT组和观察组1期和2期ONFH（即塌陷前期）的塌陷率以及全髋关节置换（THA）转换率。结果 CABMAT组和观察组分别有232例（平均随访：8.2年）和106例（平均随访：6.0年）患者。在ONFH的分期、类型和相关因素方面，未观察到显著的组间差异。CABMAT组和观察组塌陷前期的塌陷率分别为67.1%和65.3%。对于1期，观察组的塌陷率显著低于CABMAT组（p<0.05）。CABMAT组和观察组的总体THA转换率分别为24.3%和41.5%（p<0.0001）。对于3A期和3B期（塌陷期）的ONFH，CABMAT组的THA转换率显著更低（p<0.05）。结论 1期ONFH的塌陷率显著更高；对于塌陷期，CABMAT组的THA转换率显著低于观察组。因此，对于1期ONFH建议采用观察治疗，对于更高分期的ONFH建议采用CABMAT治疗。
