Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany.
Arch Orthop Trauma Surg. 2020 Nov;140(11):1603-1609. doi: 10.1007/s00402-020-03339-0. Epub 2020 Jan 20.
The aim of the study was to compare decompression of bone-marrow edema or osteonecrosis of the proximal femur by means of a cone beam-based imaging and navigation system (cone beam-navigated decompression, CBND) with decompression by the conventional technique of drilling using fluoroscopy (FD).
The data of patients with bone-marrow edema syndrome treated between 2016 and 2018 by drilling of the proximal femur in CBND or FD technique were compared retrospectively.
Each treatment group included 20 patients. The mean operating time for CBND was 16.4 ± 5.8 min, compared with 29.1 ± 20.8 min for FD (p = 0.018). The lesion was definitely reached by CBND in 19/20 patients. Eighteen of the 20 patients in the CBND group reported that their pain decreased after the treatment, compared with 12/20 patients in the FD group (p = 0.065). The radiation dosage was significantly higher (p < 0.001) for CBND than for FD.
Decompression by CBND can be carried out safely and without complications. The advantages of CBND over FD are the minimally invasive access and the ability to address the affected area precisely with only one drilling maneuver. The high radiation dose of CBND can be reduced using low-dose protocols.
本研究的目的是比较基于锥形束成像和导航系统（锥形束导航减压，CBND）与透视引导下常规钻孔减压（FD）治疗股骨近端骨髓水肿或骨坏死的效果。
回顾性比较了 2016 年至 2018 年间采用 CBND 或 FD 技术对股骨近端进行钻孔治疗骨髓水肿综合征患者的数据。
每组各 20 例患者。CBND 的平均手术时间为 16.4±5.8 分钟，而 FD 为 29.1±20.8 分钟（p=0.018）。CBND 能明确到达 19/20 例患者的病灶。CBND 组 18/20 例患者治疗后疼痛减轻，而 FD 组仅 12/20 例（p=0.065）。CBND 的辐射剂量明显高于 FD（p<0.001）。
CBND 减压可安全进行，无并发症。与 FD 相比，CBND 的优势在于微创入路和仅通过一次钻孔操作即可精确处理受累区域。CBND 的高辐射剂量可通过低剂量方案降低。
