Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany.
Int Orthop. 2011 Oct;35(10):1461-6. doi: 10.1007/s00264-010-1138-x. Epub 2010 Oct 24.
The osteonecrosis of the femoral head implies significant disability partly due to pain. After conventional core decompression using a 10-mm drill, patients normally are requested to be non-weight bearing for several weeks due to the risk of fracture. After core decompression using multiple small drillings, patients were allowed 50% weight bearing. The alternative of simultaneous implantation of a tantalum implant has the supposed advantage of unrestricted load bearing postoperatively. However, these recommendations are mainly based on clinical experience. The aim of this study was to perform a finite element analysis and confirm the results by clinical data after core decompression and after treatment using a tantalum implant. Postoperatively, the risk of fracture is lower after core decompression using multiple small drillings and after the implantation of a tantalum rod according to finite element analysis compared to core decompression of one 10-mm drill hole. According to the results of this study, a risk of fracture exists only during extreme loading. The long-term results reveal a superior performance for core decompression presumably due to the lack of complete bone ingrowth of the tantalum implant. In conclusion, core decompression using small drill holes seems to be superior compared to the tantalum implant and to conventional core decompression.
股骨头坏死会导致严重的残疾，部分原因是疼痛。在使用 10mm 钻头进行传统的核心减压后，由于存在骨折风险，患者通常需要数周的非负重。在使用多个小钻头进行核心减压后，患者可以承受 50%的体重。同时植入钽植入物的替代方案据称具有术后不受限制的承重优势。然而，这些建议主要基于临床经验。本研究的目的是进行有限元分析，并通过核心减压和钽植入物治疗后的临床数据进行验证。术后，与使用单个 10mm 钻头进行核心减压相比，使用多个小钻头进行核心减压和植入钽棒的有限元分析显示术后骨折风险较低。根据这项研究的结果，只有在极端负荷下才存在骨折风险。长期结果表明，核心减压的效果更好，这可能是由于钽植入物没有完全骨长入。总之，与使用钽植入物和传统核心减压相比，使用小钻头进行核心减压似乎更具优势。
