Schneider W, Breitenseher M, Engel A, Knahr K, Plenk H, Hofmann S
II. Allgemein Orthopädische Abteilung, Orthopädisches Spital Wien-B Speising.
Orthopade. 2000 May;29(5):420-9. doi: 10.1007/s001320050463.
Core decompression of the necrotic area for treatment of idiopathic osteonecrosis of the femoral head was developed and published by Ficat and Arlet in 1962 within the scope of their "Functional exploration of bone". The mode of action is attributed to a reduction of the intramedullary pressure in the bony compartment of the femoral head. The possibilities of repair and bone regeneration following core decompression are still discussed controversially. Core decompression is a common but not generally accepted procedure in the treatment of idiopathic osteonecrosis of the femoral head. After first publications of positive mid- and long-term effects, some subsequent studies judged it as an ineffective and high-risk method. Analysis of the literature shows that the effectiveness of core decompression depends on the stage of osteonecrosis at the time of surgical intervention. Prognosis is influenced by the extent and location of the necrotic area, the presence and amount of head depression, and continued risk factors--mainly corticoid medication. The best prognosis can be given for patients with a small, medial-centrally located necrosis without head depression. The classification according to Ficat appears to be insufficient, as the extent and localization of the necrotic area are not assessed. Magnetic resonance imaging has become a diagnostic gold standard, as radiographic diagnosis showed poor sensitivity and specificity, especially in the early stages of the disease. As an essential part, MRI was integrated into the new classification of the "Association Internationale de Recherche sur la Circulation Osseuse" (ARCO). On account of the literature and our own experience, treatment by core decompression can be recommended in cases of reversible early stages of osteonecrosis (ARCO 1), as well as in those cases of irreversible early stages (ARCO 2) that show a medial or central location of the necrosis with an extent of less than 30% of the femoral head. Once the disease reaches the irreversible early stage, complete recovery cannot be expected. In these cases only reduction of pain and retardation of the natural course of the osteonecrosis are possible to gain time until total hip replacement is unavoidable.
1962年，菲卡特（Ficat）和阿莱（Arlet）在其“骨的功能探索”范围内开发并发表了用于治疗股骨头特发性骨坏死的坏死区域髓芯减压术。其作用方式归因于降低股骨头骨腔内的髓内压力。髓芯减压术后修复和骨再生的可能性仍存在争议。髓芯减压术是治疗股骨头特发性骨坏死的一种常见但未被普遍接受的方法。在首次发表关于其积极的中长期效果后，一些后续研究认为它是一种无效且高风险的方法。文献分析表明，髓芯减压术的有效性取决于手术干预时骨坏死的阶段。预后受坏死区域的范围和位置、股骨头塌陷的存在及程度以及持续的风险因素（主要是皮质类固醇药物治疗）影响。对于坏死区域小、位于股骨头内侧中央且无股骨头塌陷的患者，预后最佳。菲卡特分类法似乎并不充分，因为未评估坏死区域的范围和定位。磁共振成像已成为诊断金标准，因为X线诊断显示出较差的敏感性和特异性，尤其是在疾病早期。作为重要组成部分，磁共振成像被纳入了“国际骨循环研究协会”（ARCO）的新分类中。根据文献和我们自己的经验，对于骨坏死可逆早期阶段（ARCO 1期）以及坏死位于内侧或中央、范围小于股骨头30%的不可逆早期阶段（ARCO 2期）的病例，可推荐采用髓芯减压术治疗。一旦疾病发展到不可逆早期阶段，就不能期望完全康复。在这些情况下，只能减轻疼痛并延缓骨坏死的自然病程，以争取时间，直到不可避免地需要进行全髋关节置换。
