Theopold Jan, Armonies Sarah, Pieroh Philipp, Hepp Pierre, Roth Andreas
Department of Orthopedic, Trauma and Plastic Surgery, Division of Arthroscopy, Joint Surgery and Sport Injuries, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany.
Oper Orthop Traumatol. 2020 Apr;32(2):107-115. doi: 10.1007/s00064-019-00643-w. Epub 2019 Nov 28.
The aim is to address core decompression and pathologies of the femoral head, treating them during the same procedure. Furthermore, radiation exposure will be reduced.
Femoral head necrosis ARCO (Association Research Circulation Osseous) stages I-III.
Progressive femoral head necrosis as ARCO stages IIIC-IV.
Arthroscopically navigated core decompression of the femoral head using an established optoelectronic system with fluoro-free software module. First, hip joint arthroscopy was performed and further pathologies were treated. Second, core decompression was navigated by a navigation pointer and drill sleeve to reach the correct target point. After visualization, the procedure is repeated 3-5 times.
Limited weight bearing of the operated leg (20 kg) for 10-14 days. Active or passive continuous motion machine for 4 weeks. Adjuvant postoperative indomethacin therapy for 10 days to reduce pain and bone marrow edema.
From May 2018 to January 2019, 7 patients (male = 4; 40 ± 9 years) underwent arthroscopically navigated core decompression with 2 (29%) and 5 (71%) patients being classified as ARCO II and III, respectively. Preoperatively, all patients reported load-dependent pain. In all cases, we could identify synovitis, which results in soft tissue release and synovectomy. Furthermore, 4 of 7 patients had an additional labrum lesion, which is addressed by refixation or shrinking.
Compared to the conventional technique, this fluoro-free navigation procedure allows more precise drilling. Moreover, additional pathologies, as found in all our cases, could be simultaneously addressed. The intraoperative radiation exposure for the patient and surgical team could also be reduced. Although arthroscopically assisted core decompression requires more preparation time, there are advantages over conventional surgery.
旨在解决股骨头的髓芯减压及病变问题，并在同一手术过程中进行治疗。此外，还将减少辐射暴露。
骨循环研究协会（ARCO）I - III期股骨头坏死。
ARCO IIIC - IV期进行性股骨头坏死。
使用具有无荧光软件模块的成熟光电系统，在关节镜引导下对股骨头进行髓芯减压。首先，进行髋关节镜检查并治疗其他病变。其次，通过导航指针和钻套引导髓芯减压，以到达正确的靶点。可视化后，该操作重复3 - 5次。
术侧腿限制负重（20千克）10 - 14天。使用主动或被动连续运动机器4周。术后辅助使用吲哚美辛治疗10天，以减轻疼痛和骨髓水肿。
2018年5月至2019年1月，7例患者（男性4例；年龄40±9岁）接受了关节镜引导下的髓芯减压，其中2例（29%）和5例（71%）患者分别被归类为ARCO II期和III期。术前，所有患者均报告有负重依赖性疼痛。在所有病例中，我们都能发现滑膜炎，对此进行软组织松解和滑膜切除术。此外，7例患者中有4例存在额外的盂唇损伤，通过重新固定或收缩进行处理。
与传统技术相比，这种无荧光导航程序允许更精确的钻孔。此外，在我们所有病例中发现的其他病变也可以同时处理。患者和手术团队的术中辐射暴露也可以减少。尽管关节镜辅助髓芯减压需要更多的准备时间，但与传统手术相比仍有优势。
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