Winter Philipp, Landgraeber Stefan
Klinik für Orthopädie und Orthopädische Chirurgie, Universität des Saarlandes, Kirrberger Str. 100, 66421, Homburg, Deutschland.
Orthopadie (Heidelb). 2022 Oct;51(10):800-807. doi: 10.1007/s00132-022-04302-0. Epub 2022 Sep 22.
Atraumatic femoral head necrosis (aFHN) in adults is estimated to be the leading cause of approximately 10% of all hip prosthesis implantations. Due to the relatively frequent occurrence of aFHN at a young age, the possibility of a joint-preserving intervention should be examined. This includes the classic "core decompression" and modifications based on it. There are different data on the success rates of this method. Reasons for treatment failure could include a lack of clearance of the necrosis zone. The clearance of the necrosis zone is taken into account by alternative surgical procedures for the treatment of aFHN. These are the "trap-door procedure", the "light-bulb procedure" and "advanced core decompression". The current state of knowledge on these procedures is reviewed in this keynote article. It is shown that the extensive excision of femoral head necrosis is of particular importance. None of the procedures mentioned can currently be recommended in preference over the others.
据估计，成人非创伤性股骨头坏死（aFHN）约占所有髋关节假体植入手术的10%，是主要病因。由于aFHN在年轻时相对频繁发生，因此应研究保留关节干预的可能性。这包括经典的“髓芯减压”及其改良方法。关于该方法的成功率有不同的数据。治疗失败的原因可能包括坏死区域清除不彻底。aFHN的替代手术治疗方法考虑了坏死区域的清除。这些方法包括“活板门手术”、“灯泡手术”和“改良髓芯减压术”。这篇主题文章回顾了这些手术方法的当前知识状态。结果表明，广泛切除股骨头坏死尤为重要。目前无法推荐上述任何一种手术方法优于其他方法。
