McGrory Brian J, York Sally C, Iorio Richard, Macaulay William, Pelker Richard R, Parsley Brian S, Teeny Steven M
American Association of Hip and Knee Surgeons, Rosemont, Illinois, USA.
J Bone Joint Surg Am. 2007 Jun;89(6):1194-204. doi: 10.2106/JBJS.F.00302.
There is currently no standardized protocol for evaluating and treating osteonecrosis of the femoral head in adults in the United States. We sought to understand current treatment practices of a group of surgeons who commonly treat this disease to determine if there was agreement on some aspects of care.
We designed a two-staged mixed-mode (mailed and faxed) sixteen-question self-administered descriptive survey questionnaire to be sent to all 753 active members of the American Association of Hip and Knee Surgeons (AAHKS). The survey design was based on Dillman's survey research methodology, and the questionnaire included hypothetical clinical scenarios based on the Steinberg classification system. The responses elucidated the opinions and treatment preferences of high-volume arthroplasty surgeons who treat adult patients with osteonecrosis of the femoral head.
Of the 753 active members of the AAHKS, 403 (54%) responded to the questionnaire. Total hip replacement was reported to be the most frequent intervention for treatment of postcollapse (Steinberg stage-IIIB, IVB, V, and VI) osteonecrosis; core decompression was reported to be the most commonly offered intervention for symptomatic, precollapse (Steinberg stage-IB and IIB) osteonecrosis. Less frequently offered treatments included nonoperative management, osteotomy, vascularized and non-vascularized bone-grafting, hemiarthroplasty, and arthrodesis.
The care of adults with osteonecrosis of the femoral head varies among American orthopaedic surgeons specializing in hip and knee surgery. A consensus may evolve with a continued concerted effort on the part of interested surgeons, but it will require randomized, controlled, prospective studies of treatment of each stage of the disease and collaborative multicenter studies.
Therapeutic Level V.
在美国，目前尚无用于评估和治疗成人股骨头坏死的标准化方案。我们试图了解一组经常治疗该疾病的外科医生的当前治疗方法，以确定在某些护理方面是否存在共识。
我们设计了一份包含16个问题的两阶段混合模式（邮寄和传真）自填式描述性调查问卷，将其发送给美国髋膝关节外科医生协会（AAHKS）的所有753名活跃会员。该调查设计基于迪尔曼的调查研究方法，问卷包括基于斯坦伯格分类系统的假设临床场景。这些回答阐明了大量治疗成人股骨头坏死患者的关节置换外科医生的意见和治疗偏好。
AAHKS的753名活跃会员中，403名（54%）回复了问卷。据报告，全髋关节置换是治疗塌陷后（斯坦伯格III B期、IV B期、V期和VI期）股骨头坏死最常用的干预措施；据报告，核心减压是有症状的塌陷前（斯坦伯格I B期和II B期）股骨头坏死最常采用的干预措施。较少采用的治疗方法包括非手术治疗、截骨术、带血管和不带血管的骨移植、半髋关节置换术和关节融合术。
在美国，专门从事髋膝关节手术的骨科医生对成人股骨头坏死的治疗方法各不相同。感兴趣的外科医生持续共同努力可能会形成共识，但这需要对疾病各阶段的治疗进行随机、对照、前瞻性研究以及多中心合作研究。
治疗性水平V。
