Department of Orthopaedics, University of Duisburg-Essen, Germany.
J Tissue Eng Regen Med. 2013 Nov;7(11):893-900. doi: 10.1002/term.1481. Epub 2012 Apr 4.
Aseptic necrosis of the femoral head (AVN) leads to destruction of the affected hip joint, predominantly in younger patients. Advanced core decompression (ACD) is a new technique that may allow better removal of the necrotic tissue by using a new percutaneous expandable reamer. A further modification is the refilling of the drill hole and the defect with an injectable, hard-setting, composite calcium sulphate (CaSO₄)-calcium phosphate (CaPO₄) bone graft substitute. Compression tests were performed on seven pairs of femoral cadaver bones. One femur of each pair was treated with ACD, while the opposite side remained untreated. Clinically, the postoperative outcome of 27 hips in 23 patients was performed by physical examination 6 weeks after ACD and at average follow-up of 9.69 months, and compared with the preoperative results. MRI was used to assess the removal of the necrotic tissue, any possible progression of AVN and evaluation of collapse. In the biomechanical analysis, the applied maximum compression force that caused the fracture did not significantly differ from the untreated opposite side. The overall results of postoperative physical examinations were significantly better than preoperatively. Five hips (18.5%) were converted to a total hip replacement. The follow-up MRIs of the other patients showed no progression of the necrotic area. The first follow-up results of ACD have been encouraging for the early stages of aseptic necrosis of the femoral head. In our opinion, an assured advantage is the high stability of the femoral neck after ACD, which allows quick rehabilitation.
股骨头无菌性坏死（AVN）会导致受影响的髋关节破坏，主要发生在年轻患者中。先进的核心减压（ACD）是一种新技术，它可以通过使用新的经皮可扩张扩孔器更好地清除坏死组织。进一步的改进是用可注射的、硬固的、复合硫酸钙（CaSO₄）-磷酸钙（CaPO₄）骨移植替代物填充钻孔和缺陷。对 7 对股骨尸体骨进行了压缩试验。每对股骨中的一根接受 ACD 治疗，而另一侧则未接受治疗。临床方面，对 23 名患者的 27 髋进行了术后 6 周的体格检查和平均 9.69 个月的随访，并与术前结果进行了比较。MRI 用于评估坏死组织的清除、AVN 的任何可能进展以及塌陷的评估。在生物力学分析中，导致骨折的最大压缩力与未治疗的对侧没有显著差异。术后体格检查的总体结果明显好于术前。5 髋（18.5%）被转换为全髋关节置换。其他患者的随访 MRI 显示坏死区域没有进展。ACD 的早期随访结果令人鼓舞，适用于股骨头无菌性坏死的早期阶段。在我们看来，ACD 后股骨颈的高稳定性是一个可靠的优势，它允许快速康复。
