Landgraeber Stefan, Warwas Sebastian, Claßen Tim, Jäger Marcus
Department of Orthopaedics and Trauma surgery, University Hospital of Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
BMC Musculoskelet Disord. 2017 Nov 21;18(1):479. doi: 10.1186/s12891-017-1811-y.
"Advanced Core Decompression" (ACD) is a new technique for treatment of osteonecrosis of the femoral head (ONFH) that includes removal of the necrotic tissue using a percutaneous expandable reamer followed by refilling of the drill hole and the defect with an injectable, hard-setting, composite calcium sulphate (CaSO)-calcium phosphate (CaPO) bone graft substitute. As autologous bone has been shown to be superior to all other types of bone grafts, the aim of the study is to present and evaluate a modified technique of ACD with impaction of autologous bone derived from the femoral neck into the necrotic defect.
A cohort of patients with an average follow-up of 30.06 months (minimum 12 months) was evaluated for potential collapse of the femoral head and any reasons that led to replacement of the operated hip. Only patients in stages 2a to 2c according to the Steinberg classification were included in the study.
In 75.9% the treatment was successful with no collapse of the femoral head or conversion to a total hip replacement. Analysis of the results of the different subgroups showed that the success rate was 100% for stage 2a lesions and 84.6% respectively 61.5% for stages 2b and 2c lesions.
Previous studies with a comparable follow-up reported less favourable results for ACD without autologous bone. Especially in stages 2b and 2c the additional use of autologous bone has a positive effect. In comparison to other hip-preserving techniques, the modified ACD technique is a very promising and minimally invasive method for treatment of ONFH.
German clinical trials register ( DRKS00011269 , retrospectively registered).
“高级髓芯减压术”（ACD）是一种治疗股骨头坏死（ONFH）的新技术，该技术包括使用经皮可扩张铰刀清除坏死组织，随后用可注射的、硬固化的硫酸钙（CaSO）-磷酸钙（CaPO）复合骨移植替代物填充钻孔和缺损处。由于自体骨已被证明优于所有其他类型的骨移植材料，本研究的目的是介绍并评估一种改良的ACD技术，即将取自股骨颈的自体骨嵌入坏死缺损处。
对一组平均随访30.06个月（最短12个月）的患者进行评估，以确定股骨头是否可能塌陷以及导致手术髋关节置换的任何原因。本研究仅纳入根据斯坦伯格分类处于2a至2c期的患者。
75.9%的治疗取得成功，股骨头未塌陷，也未转换为全髋关节置换。对不同亚组结果的分析表明，2a期病变的成功率为100%，2b期和2c期病变的成功率分别为84.6%和61.5%。
先前随访时间相当的研究报告显示，无自体骨的ACD效果较差。特别是在2b期和2c期，额外使用自体骨具有积极作用。与其他保髋技术相比，改良的ACD技术是一种非常有前景的微创治疗ONFH的方法。
德国临床试验注册中心（DRKS00011269，回顾性注册）
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