Karimi Mehdi, Moharrami Alireza, Vahedian Aedakani Mohammad, Mirghaderi Seyed Peyman, Ghadimi Ehsan, Mortazavi Sm Javad
Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Arch Bone Jt Surg. 2023;11(8):517-523. doi: 10.22038/ABJS.2022.61327.3011.
Avascular necrosis of the femoral head typically occurs in the young population. Core decompression in the precollapse stage provides pain relief and preservation of the femoral head. The results of core decompression vary considerably despite the early diagnosis. Clinicians concur that primary treatment should focus on preserving the natural surface of the joint. This study investigated the predictive risk factors of failure in femoral head decompression.
We retrospectively reviewed 135 patients and 207 hips (77 male (127 hips) and 58 female (80 hips)) who underwent core decompression (mean age: 34.7 years [age range: 21-71]) from April 2010 to December 2017. All patients were followed by a mean of 57 months. All hips were in the precollapse stage (Ficat I, II).
A total of 207 hips were treated with core decompression surgery, and the overall success rate was 58%. The higher grade of Kerboul, Ficat, ARCO classifications, multifocal avascular necrosis of the femoral head, smoking, opium, and corticosteroids were significantly associated with a higher failure rate after core decompression in univariate analysis. In multivariate logistic regression analysis, the Kerboul and Ficat classifications, alcohol consumption, and multifocal avascular necrosis of the femoral head were significantly correlated with core decompression failure. The most common predictive factors in core decompression failure were Ficat II, Kerboul stage 3, multifocal avascular necrosis of the femoral head, and alcohol consumption.
In conclusion, we had an overall 58 % success rate in core decompression of femoral head avascular necrosis. Based on the results of this study, imaging evaluation and imaging-based classifications are the most valuable predictor factors for the success of core decompression. Consistent with previous reports, corticosteroid was not a significant predictor of core decompression failure.
股骨头缺血性坏死通常发生于年轻人群。塌陷前期的髓芯减压可缓解疼痛并保留股骨头。尽管早期诊断，但髓芯减压的结果差异很大。临床医生一致认为，主要治疗应侧重于保留关节的自然表面。本研究调查了股骨头减压失败的预测风险因素。
我们回顾性分析了2010年4月至2017年12月期间接受髓芯减压的135例患者和207髋（男性77例（127髋），女性58例（80髋））（平均年龄：34.7岁[年龄范围：21 - 71岁]）。所有患者平均随访57个月。所有髋关节均处于塌陷前期（Ficat I、II期）。
共有207髋接受了髓芯减压手术，总体成功率为58%。单因素分析中，Kerboul、Ficat、ARCO分级越高，股骨头多灶性缺血性坏死、吸烟、鸦片及使用皮质类固醇与髓芯减压术后较高的失败率显著相关。多因素逻辑回归分析中，Kerboul和Ficat分级、饮酒及股骨头多灶性缺血性坏死与髓芯减压失败显著相关。髓芯减压失败最常见的预测因素为Ficat II期、Kerboul 3期、股骨头多灶性缺血性坏死及饮酒。
总之，我们对股骨头缺血性坏死进行髓芯减压的总体成功率为58%。基于本研究结果，影像学评估及基于影像学的分类是髓芯减压成功最有价值的预测因素。与既往报道一致，皮质类固醇并非髓芯减压失败的显著预测因素。
