Shiravani Brojeni Shahram, Hesarikia Hamid, Rahimnia Amirhossein, Emami Meybodi Mohammad Kazem, Rahimnia Alireza
Department of Orthopedic Surgery, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Trauma Research Center, Department of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Arch Bone Jt Surg. 2020 Sep;8(5):613-619. doi: 10.22038/abjs.2020.49380.2452.
Femoral head avascular necrosis is the cause of paralyzing status of youth population. Initial diagnosis is the main element in treating the disease. Bone grafting and core decompression are the approved cures at the early steps of the disease. Hip replacement in a total manner is the common cure in the final stages. The optimal treatment in the intermediate stages is partially disputable. We investigated several patients with femoral head osteonecrosis cured with impacted cancellous allograft and open core decompression using the lightbulb technique.
A total of 46 patients (58 hips) suffering from femoral head osteonecrosis were evaluated in this cross-sectional study. Patients were classified into two groups: A (stage 2B Ficat) and B (stage 3 Ficat) to be treated with the impaction of cancellous allograft and by open core decompression. Radiographic results, demographic data, and range of hip joint motions were recorded. The patients were assessed through employing the Harris hip score (HHS) and visual analogue scale (VAS) index prior to operation and over five years following surgery. We also studied radiographic alterations of femoral head.
The means of HHS and VAS were developed following the operation. Radiographic outcomes promoted in both groups, however, it was better in group A. 12 (40%) and six (22%) hips (40%) in groups A and B, respectively displayed developed stages following the operation. The hip ROM was enhanced with the mean of 15-20 degrees ().
Open core decompression combined with allograft impaction sounds to be influential in the developing steps of femoral head necrosis and leads to joint discomfort and diminished pain improving ROM of the hip joint and meanwhile procrastinating the worsening of the disease.
股骨头缺血性坏死是导致青年人群瘫痪状态的原因。早期诊断是治疗该疾病的关键要素。骨移植和髓芯减压是疾病早期阶段认可的治疗方法。全髋关节置换是终末期常见的治疗方法。中期的最佳治疗方法存在部分争议。我们研究了几例采用同种异体松质骨打压植骨和灯泡技术开放髓芯减压治疗的股骨头坏死患者。
在这项横断面研究中,共评估了46例(58髋)股骨头坏死患者。患者分为两组:A组(Ficat 2B期)和B组(Ficat 3期),采用同种异体松质骨打压植骨和开放髓芯减压治疗。记录影像学结果、人口统计学数据和髋关节活动范围。在手术前及术后五年采用Harris髋关节评分(HHS)和视觉模拟量表(VAS)指数对患者进行评估。我们还研究了股骨头的影像学改变。
术后HHS和VAS均值有所改善。两组的影像学结果均有改善,但A组更好。A组和B组分别有12髋(40%)和6髋(22%)在术后显示出病情进展。髋关节活动度平均增加了15 - 20度。
开放髓芯减压联合同种异体骨打压植骨在股骨头坏死的发展阶段似乎有影响,可减轻关节不适和疼痛,改善髋关节活动度,同时延缓疾病恶化。