分析髓芯减压联合自体骨髓单核细胞移植治疗股骨头坏死病例临床失败因素。

回顾性分析中日友好医院2011年7月至2012年9月行髓芯减压联合自体骨髓单核细胞移植治疗股骨头坏死的患者38例(50髋)，男28例，女10例，平均年龄31.9岁。经5年随访，失随访3例5髋，根据术前影像学资料分别对其行国际骨循环研究会(ARCO)分期和中日友好医院分型，并行Harris评分。术后使用Harris评分对其行临床效果评价，并行影像学检测。数据比较采用Pearson检验。

截止到末次随访，随访病例中19髋行关节置换，Harris评分低于70分但未行关节置换3例。其中ARCO Ⅱ期(4/18，其中ⅡB和ⅡC各2髋)，ARCO ⅢA(15/24)、ARCO ⅢB(3/3)期临床失败率分别为22.2%、62.5%、100.0%，检验值为10.03，似然比值11.54，线性相关卡方值9.81，差异均有统计学意义(P＝0.07、0.03、0.02)。中日友好医院分型L2型(2/3)、L3型(19/25)、(C＋L1)(1/17)型患者临床失败率分别为66.7%、76.0%、5.9%，检验值为20.32，似然比值23.38，线性相关卡方值19.14，差异均有统计学意义(P值均为0.00)。分期和分型是术后临床失败的危险因素。术后Harris评分平均为82.21分。

本次研究观察结果表明髓芯减压联合自体骨髓单核细胞移植应用于股骨头坏死病例的治疗中，对ARCOⅢ期，中日友好医院L2、L3型(坏死累及外侧柱)患者术后临床失败率较高，适合ARCO Ⅱ期，中日友好医院分型L1型和C型患者。

To retrospectively analyze the clinical failure effect of core decompression with implantation of autologous bone marrow mononuclear cells for the treatment of osteonecrosis of the femoral head(ONFH).

In total, 38 patients (50 hips) underwent core decompression and implantation of autologous bone marrow mononuclear cells for treatment of ONFH during the period from July 2011 to September 2012. There were 28 male and 10 female cases, with an average age of 31.9. Three patients (5 hips) lost follow up. The patients were classified by their Association Research Circulation Osseous(ARCO) staging and China-Japan Friendship Hospital (CJFH) typing system. The clinical evaluation was conducted by pre-and post-operative Harris hip scores (HHS). The data were analyzed by Pearson test.

Hip replacement surgery was performed for 19 hips; 3 hips Harris score of less than 70 but did not undergo total hip arthroplasty. Surgical failure rates for patients belonging to ARCO stage Ⅱ, ⅢA and ⅢB were 22.2%、62.5%、100%, value 10.03, likelihood ratio 11.54, linear-by-linear association 9.81. The failure rates of L2, L3 and (C+ L1) type were 66.7%, 76.0%, 5.9%, value 20.32, likelihood ratio 23.38, linear-by-linear association 19.14. There were significant differences between different stages and types(with P values were 0.00).

Stage and type are risk factors of this surgery. Patients belonging to ARCO Ⅲ and those with necrotic lesions involving the lateral pillar (L2 and L3 type) showed high surgical failure rates. The best indications of this procedure are for ARCO stage Ⅱ and CJFH L1 and C type.