Steinberg M E
Department of Orthopedic Surgery, University of Pennsylvania School of Medicine, Philadelphia 19104-4283.
Can J Surg. 1995 Feb;38 Suppl 1:S18-24.
To evaluate the effectiveness and safety of core decompression in the treatment of avascular necrosis (AVN) of the femoral head.
A case study.
The department of orthopedic surgery in a major university hospital.
All patients with AVN of the femoral head, stages I to IVA, were included regardless of the cause of the necrosis. Three hundred hips were available for analysis. The follow-up ranged from 2 to 12 years.
Core decompression of the femoral head was performed with an 8-mm Michele trephine inserted from just below the greater trochanter into the centre of the necrotic lesion to within 5 mm of the articular surface. Two more trephine tracts were made with a 5-mm or 6-mm trephine. The normal portion of cancellous bone recovered from the intertrochanteric region was thinned with a rongeur and was placed loosely into the central decompression channel at the end of the procedure to serve as a graft.
Anteroposterior and lateral radiographs, taken immediately before surgery and at the final follow-up, clinical hip evaluation according to the Harris scoring system, and the need for total hip replacement.
One patient sustained a subcapital fracture 1 month after surgery due to a fall. There was one case of nonfatal pulmonary embolism, one case of pneumonia and one case of thrombophlebitis of the thigh. Forty-six percent of operatively managed hips showed no radiographic progression of disease compared with only 19% of nonoperatively managed hips. Thirty-five percent of the operatively managed hips required total hip replacement compared with 77% of nonoperatively managed hips. The results in hips with early (stages I and II) AVN were only slightly better than those of hips with advanced (stages III and IVA) disease. However, the results in hips with small areas of necrosis in both stages I and II were much better than those with larger lesions; only 7% of the former group required total hip replacement after decompression and cancellous bone grafting.
Core decompression with cancellous bone grafting is a safe and effective procedure for the treatment of early AVN of the femoral head. Results with this form of treatment are considerably better than those obtained in patients treated nonoperatively. Decompression with or without bone grafting is the author's treatment of choice for patients with early AVN of the femoral head.
评估股骨头减压术治疗股骨头缺血性坏死（AVN）的有效性和安全性。
病例研究。
一所主要大学医院的骨外科。
纳入所有I至IVA期股骨头缺血性坏死患者，无论坏死原因如何。共有300个股骨头可供分析。随访时间为2至12年。
采用8毫米Michele环锯从大转子下方插入坏死病灶中心，距关节面5毫米以内进行股骨头减压。再用5毫米或6毫米环锯制作另外两条环锯通道。从转子间区域获取的松质骨正常部分用咬骨钳削薄，在手术结束时松散地放入中央减压通道作为植骨。
术前及末次随访时的前后位和侧位X线片、根据Harris评分系统进行的临床髋关节评估以及全髋关节置换的需求。
1例患者术后1个月因跌倒发生股骨头下骨折。有1例非致命性肺栓塞、1例肺炎和1例大腿血栓性静脉炎。接受手术治疗的髋关节中，46%的病例疾病无影像学进展，而非手术治疗的髋关节中这一比例仅为19%。接受手术治疗的髋关节中，35%需要进行全髋关节置换，而非手术治疗的髋关节中这一比例为77%。早期（I期和II期）AVN髋关节的结果仅略优于晚期（III期和IVA期）疾病的髋关节。然而，I期和II期坏死面积较小的髋关节结果远优于坏死面积较大的髋关节；减压及松质骨植骨后，前一组仅7%需要进行全髋关节置换。
松质骨植骨的减压术是治疗早期股骨头缺血性坏死的安全有效方法。这种治疗方式的结果明显优于非手术治疗患者。对于早期股骨头缺血性坏死患者，无论是否植骨，减压术都是作者的首选治疗方法。
