OBJECTIVES Autologous peripheral blood stem cell (auto-PBSC) transplantation is an effective therapeutic for the osteonecrosis of the femoral head (ONFH) but without prognosis estimation. This study mainly aimed to (1) determine whether auto-PBSC transplantation is a promising option, (2) assess the risk of hip-preservation failure, (3) achieve a predictive model of femoral head survival after the intervention, and (4) eventually identify clinical indications for auto-PBSC transplantation in future. METHODS After reviewing the in-patient database of the First Affiliated Hospital of Zhejiang Chinese Medicine University from June 2012 to June 2014, 37 eligible patients with Association Research Circulation Osseous stage I or II ONFH who were receiving intra-arterial infusion of auto-PBSCs were recruited. A case form was designed to retrieve relevant data. Hip-preservation failure was defined as the endpoint. All participants were stratified by the categorical risk of collapse, which was statistically tested through log-rank analysis. All significant factors were evaluated using Cox proportional hazards regression model, and a predictive nomogram plot was generated. RESULTS In total, 47 hips were followed up for 53.96 ± 21.09 months; the median survival time was 60.18 months. Among the predictors, body mass index (BMI; P = 0.0015) and Harris hip score (HHS; P < 0.0001) independently affected femoral head survival. Patients with BMI ≥ 24 kg/m2 exhibited a 2.58 times higher risk of hip-preservation failure [95% confidence interval (CI), 1.32-5.45] than those with BMI < 24 kg/m2, whereas those with HHS ≥ 70 exhibited a 0.19 times lower risk (95% CI, 0.09-0.38) than those with HHS < 70. Hazard ratios associated with age (P = 0.042), BMI (P = 0.012), HHS (P = 0.022), and necrotic volume (P = 0.000) were 1.038 (95% CI, 1.001-1.075), 1.379 (95% CI, 1.072-1.773), 0.961 (95% CI, 0.928-0.994), and 1.258 (95% CI, 1.120-1.412), respectively. A nomogram plot (score test P = 0.000; C-index = 0.8863) was available for the orthopedic doctor to predict hip survival probability. CONCLUSIONS The results suggest that intra-arterial infusion of auto-PBSCs prolongs femoral head survival. Age, BMI, HHS, and necrotic volume can influence the efficacy of this intervention. This study was approved by ethics committee of the trial center, number 2019-KL-075-01.

中文翻译：

---

自体外周血干细胞移植后股骨头坏死预后的预后：一项回顾性队列研究。

目的自体外周血干细胞（auto-PBSC）移植是一种有效的治疗股骨头坏死（ONFH）的方法，但没有预后的估计。这项研究的主要目的是（1）确定自动PBSC移植是否是有前途的选择;（2）评估髋关节保存失败的风险;（3）在干预后获得股骨头存活的预测模型;以及（4）最终确定将来自动PBSC移植的临床适应症。方法回顾2012年6月至2014年6月浙江中医药大学第一附属医院住院患者数据库，对37例符合条件的Ⅰ〜Ⅱ期骨化性顺应性ONFH患者进行动脉内自动PBSCs输注。被招募。案例表旨在检索相关数据。髋关节保留失败定义为端点。所有参与者均按照崩溃的分类风险进行了分层，并通过对数秩分析进行了统计学检验。使用Cox比例风险回归模型评估所有重要因素，并生成预测列线图。结果总共47髋接受了随访53.96±21.09个月; 中位生存时间为60.18个月。在预测指标中，体重指数（BMI； P = 0.0015）和哈里斯髋关节评分（HHS； P <0.0001）独立影响股骨头的存活率。BMI≥24 kg / m2的患者的髋部保持失败风险[95％置信区间（CI），1.32-5.45]比BMI <24 kg / m2的患者高2.58倍，而HHS≥70的患者显示0。与HHS <70相比，风险（95％CI，0.09-0.38）低19倍。与年龄（P = 0.042），BMI（P = 0.012），HHS（P = 0.022）和坏死体积（P = 0.000）分别为1.038（95％CI，1.001-1.075），1.379（95％CI，1.072-1.773），0.961（95％CI，0.928-0.994）和1.258（95％CI，1.120-1.412） 。骨科医师可以使用诺模图图（得分测试P = 0.000； C指数= 0.8863）来预测髋关节存活的可能性。结论结果表明，动脉内输注自体PBSC可延长股骨头的存活时间。年龄，BMI，HHS和坏死体积会影响这种干预的效果。这项研究得到了审判中心伦理委员会的批准，编号为2019-KL-075-01。和坏死体积（P = 0.000）为1.038（95％CI，1.001-1.075），1.379（95％CI，1.072-1.773），0.961（95％CI，0.928-0.994）和1.258（95％CI，1.120） -1.412）。骨科医师可以使用诺模图图（得分测试P = 0.000； C指数= 0.8863）来预测髋关节存活的可能性。结论结果表明，动脉内输注自体PBSC可延长股骨头的存活时间。年龄，BMI，HHS和坏死体积会影响这种干预的效果。这项研究得到了审判中心伦理委员会的批准，编号为2019-KL-075-01。和坏死体积（P = 0.000）为1.038（95％CI，1.001-1.075），1.379（95％CI，1.072-1.773），0.961（95％CI，0.928-0.994）和1.258（95％CI，1.120） -1.412）。骨科医师可以使用诺模图图（得分测试P = 0.000； C指数= 0.8863）来预测髋关节存活的可能性。结论结果表明，动脉内输注自体PBSC可延长股骨头的存活时间。年龄，BMI，HHS和坏死体积会影响这种干预的效果。这项研究得到了审判中心伦理委员会的批准，编号为2019-KL-075-01。骨科医师可利用这些数据来预测髋关节的存活概率（8863）。结论结果表明，动脉内输注自体PBSC可延长股骨头的存活时间。年龄，BMI，HHS和坏死体积会影响这种干预的效果。这项研究得到了审判中心伦理委员会的批准，编号为2019-KL-075-01。骨科医师可利用这些数据来预测髋关节的存活概率（8863）。结论结果表明，动脉内输注自体PBSC可延长股骨头的存活时间。年龄，BMI，HHS和坏死体积会影响这种干预的效果。这项研究得到了审判中心伦理委员会的批准，编号为2019-KL-075-01。