Benignus C, Lüring C, Beckmann J
Department Endoprothetik Untere Extremität/Fußchirurgie, Sportklinik Stuttgart GmbH, Taubenheimstraße 8, 70372, Stuttgart, Deutschland.
Orthopädische Klinik, Klinikum Dortmund gGmbH, Dortmund, Deutschland.
Oper Orthop Traumatol. 2020 Apr;32(2):89-95. doi: 10.1007/s00064-019-00640-z. Epub 2019 Nov 21.
Retrograde drilling of a necrotic zone within the femoral head to reduce intraosseous pressure and stimulate revascularization.
Atraumatic osteonecrosis of the hip ARCO stage I (reversible) and ARCO stage II (potentially reversible) with a medial or central necrotic zone <30% or ARCO stage III with a subchondral fracture for reduction of pain.
ARCO stage III C, ARCO stage IV (secondary osteoarthritis), stage-independent necrotic zone > 30%, infections.
Supine position. Visualization of the necrotic zone via an image intensifier, approach is determined by using a Kirschner wire, laterodorsal skin incision on a level with the wire, longitudinal incision of iliotibial band and vastus lateralis muscle, drilling the necrotic zone with a 2-3 mm Kirschner wire, optionally placing more wires or a hollow drill, wound closure.
Partial weightbearing with 20 kg for 6 weeks due to risk of fracture, followed by avoidance of jumping or sprinting for another 6 weeks; physiotherapy from day 1 after surgery, thromboembolic prophylaxis until full weightbearing is possible.
Results are dependent on ARCO stages and are promising in early stages.
对股骨头内坏死区域进行逆行钻孔，以降低骨内压并刺激血管再生。
髋关节非创伤性骨坏死ARCO I期（可逆）和ARCO II期（潜在可逆），内侧或中央坏死区域<30%；或ARCO III期伴有软骨下骨折以减轻疼痛。
ARCO III C期、ARCO IV期（继发性骨关节炎）、与分期无关的坏死区域>30%、感染。
仰卧位。通过影像增强器观察坏死区域，使用克氏针确定入路，在与克氏针同一水平做背外侧皮肤切口，纵行切开髂胫束和股外侧肌，用2-3毫米克氏针对坏死区域进行钻孔，可选择置入更多克氏针或空心钻，缝合伤口。
因有骨折风险，部分负重20千克，持续6周，之后6周避免跳跃或短跑；术后第1天开始进行物理治疗，进行血栓栓塞预防直至能够完全负重。
结果取决于ARCO分期，早期结果很有前景。
