Unidad de Cirugía Artroscópica, UCA Mikel Sánchez, Clínica USP-La Esperanza, c/La Esperanza 3, 01002 Vitoria-Gasteiz, Spain.
Knee Surg Sports Traumatol Arthrosc. 2012 Feb;20(2):393-8. doi: 10.1007/s00167-011-1587-9. Epub 2011 Jun 22.
The purpose is to describe a noninvasive arthroscopic procedure as an alternative to open surgery for avascular necrosis of the hip.
Patients with grade I or IIA avascular necrosis of the hip are treated by core decompression performed by drilling under fluoroscopic guidance. Liquid platelet-rich plasma (PRP) is delivered through a trocar, saturating the necrotic area. In more severe conditions, the necrotic bone is decompressed and debrided, through a cortical window at the head-neck junction. A composite graft made of autologous bone and PRP is delivered by impactation through the core decompression track. Fibrin membranes are applied to enhance healing of the head-neck window and arthroscopic portals. Platelet-rich plasma is infiltrated in the central compartment.
This arthroscopic approach aids in making diagnosis of the labrum and articular cartilage and permits intra-operative treatment decisions. Visual control permits the precise localization and treatment for the necrotic area allowing cartilage integrity to be preserved.
Arthroscopic management of avascular necrosis of the femoral head is viable and has significant advantages. Clinical studies should justify the theoretical additional benefits of this approach.
描述一种用于治疗股骨头缺血性坏死的非侵入性关节镜手术，作为开放性手术的替代方法。
采用在荧光透视引导下钻孔进行核心减压术治疗 I 级或 IIA 期股骨头缺血性坏死的患者。通过套管将富含血小板的液体 (PRP) 输送到坏死区域。在更严重的情况下，通过在头颈部交界处的皮质窗对坏死骨进行减压和清创。通过撞击将由自体骨和 PRP 制成的复合移植物通过核心减压通道输送。应用纤维蛋白膜增强头颈部窗口和关节镜入口的愈合。将富含血小板的血浆注入中央隔室。
这种关节镜方法有助于诊断唇和关节软骨，并允许进行术中治疗决策。视觉控制允许精确定位和治疗坏死区域，从而保留软骨完整性。
股骨头缺血性坏死的关节镜治疗是可行的，具有显著优势。临床研究应该证明这种方法的理论上的额外益处。
