Vlamis John, Karampinas Panagiotis, Kavroudakis Eustratios, Pneumaticos Spiros
III Orthopaedic Department KAT Hospital, University of Athens Medical School, Athens - Greece.
Hip Int. 2014 May-Jun;24(3):284-9. doi: 10.5301/hipint.5000118. Epub 2014 Feb 5.
The aim of this study is to evaluate the role of endoscopy as diagnostic and prognostic method for Ficat and Steinberg stage IIIA and IIIB lesions by assessing the efficacy, risks and complications of this method. In a prospective study from January 2008 until September 2013, nine patients (13 hips) were assessed. In nine hips the disease was stage II, in three hips stage III and in one hip stage IV. Evaluation included x-rays, magnetic resonance and bone scintigraphy. After femoral head decompression, the borders of the removed necrotic area were investigated under direct visualisation by means of endoscopy in order to assess the vitality status of the surrounding bone. Endoscopic evaluation was successful in nine hips. The visualisation of healthy bone borders after removing the necrotic bone was not possible in four cases. The preoperative MRI findings were in correlation to our endoscopic findings in five out of nine cases. There were no cases of cartilage perforation, femoral neck fracture and other intra and postoperative complications. Endoscopic evaluation of the removed necrotic bone can greatly improve the therapeutic effect by visualising the borders of the decompressed bone area and provide information regarding the necessity for bone graft and the type of graft required.
本研究旨在通过评估内窥镜检查法的有效性、风险及并发症，来评价其作为诊断和预测Ficat和Steinberg IIIA期及IIIB期病变方法的作用。在一项从2008年1月至2013年9月的前瞻性研究中，对9例患者（13髋）进行了评估。其中9髋为II期疾病，3髋为III期，1髋为IV期。评估包括X线、磁共振成像和骨闪烁显像。在股骨头减压后，通过内窥镜直视观察切除的坏死区域边界，以评估周围骨的活力状态。9髋的内窥镜评估获得成功。4例病例在切除坏死骨后无法观察到健康的骨边界。9例中有5例术前磁共振成像结果与我们的内窥镜检查结果相关。未发生软骨穿孔、股骨颈骨折及其他术中及术后并发症。通过观察减压骨区域的边界，对切除的坏死骨进行内窥镜评估可大大提高治疗效果，并为骨移植的必要性及所需移植骨类型提供信息。
