Koo K H, Kim R, Ko G H, Song H R, Jeong S T, Cho S H
Department of Orthopaedic Surgery, Gyeong-Sang National University School of Medicine, Chinju, Republic of Korea.
J Bone Joint Surg Br. 1995 Nov;77(6):870-4.
We performed a randomised trial on 37 hips (33 patients) with early-stage osteonecrosis (ON). After the initial clinical evaluation, including plain radiography and MRI, 18 hips were randomly assigned to a core-decompression group and 19 to a conservatively-treated group. All the patients were regularly followed up by clinical evaluation, plain radiography and MRI at intervals of three months. Hip pain was relieved in nine out of ten initially symptomatic hips in the core-decompression group but persisted in three out of four initially painful hips in the conservatively-treated group at the second assessment (p < 0.05). At a minimum follow-up of 24 months, 14 of the 18 core-decompressed hips (78%) and 15 of the 19 non-operated hips (79%) developed collapse of the femoral head. By survival analysis, there was no significant difference in the time to collapse between the two groups (log-rank test p = 0.79). Core decompression may be effective tin symptomatic relief, but is of no greater value than conservative management in preventing collapse in early osteonecrosis of the femoral head.
我们对37例（33名患者）早期股骨头坏死（ON）的髋关节进行了一项随机试验。在包括X线平片和磁共振成像（MRI）在内的初始临床评估后，18例髋关节被随机分配至髓芯减压组，19例被分配至保守治疗组。所有患者每隔三个月通过临床评估、X线平片和MRI进行定期随访。在第二次评估时，髓芯减压组最初有症状的10例髋关节中有9例髋关节疼痛得到缓解，而保守治疗组最初疼痛的4例髋关节中有3例疼痛持续存在（p<0.05）。在至少24个月的随访中，18例接受髓芯减压的髋关节中有14例（78%）以及19例未手术的髋关节中有15例（79%）发生了股骨头塌陷。通过生存分析，两组之间塌陷时间无显著差异（对数秩检验p=0.79）。髓芯减压可能在缓解症状方面有效，但在预防早期股骨头坏死塌陷方面并不比保守治疗更具价值。
