Wirtz C, Zilkens K W, Adam G, Niethard F U
Orthopädische Universitätsklinik der RWTH Aachen.
Z Orthop Ihre Grenzgeb. 1998 Mar-Apr;136(2):138-46. doi: 10.1055/s-2008-1051296.
We evaluated the signal changes of avascular necrosis and transient bone marrow oedema before and after core decompression of the femoral head to deduce prognostic factors for this operative procedure.
38 to 40 cases with core decompression (35 patients, medium age 44 years) were analysed with a mean follow-up time of 26 months. Preoperatively patients were staged by the ARCO classification. MR-images were judged in accordance to the criteria of Mitchell and Steinberg. The clinical outcome was analysed according to the hip index of Merle D'Aubigne.
All hips with transient bone marrow oedema showed normal signal patterns at an average of 3 months after core decompression. In stage I and II, all patients with a preoperative necrosis area less than 30% of the femoral head showed a reduction of the necrotic zone and good clinical results. An unchanged or progressive appearance was observed in necrotic lesions with more than 30% head involvement. Because of failure a renewed operation had to be done in all patients with stage III and IV.
In the case of transient bone marrow oedema, a restitutio ad integrum can be achieved with core decompression. In stage I and II of avascular necrosis, the successful outcome depends on the lesion size of the femoral head. Necrotic lesions less than 30% seem to have the best prognosis. In stage III and IV, core decompression cannot be recommended.
我们评估了股骨头减压术前和术后无血管性坏死及短暂性骨髓水肿的信号变化，以推断该手术的预后因素。
分析了38至40例进行减压术的患者（35例患者，平均年龄44岁），平均随访时间为26个月。术前根据ARCO分类对患者进行分期。根据Mitchell和Steinberg的标准判断磁共振图像。根据Merle D'Aubigne髋关节指数分析临床结果。
所有出现短暂性骨髓水肿的髋关节在减压术后平均3个月时显示信号模式正常。在I期和II期，所有术前坏死面积小于股骨头30%的患者坏死区缩小，临床效果良好。坏死累及超过30%股骨头的病变观察到无变化或进展。由于手术失败，所有III期和IV期患者都必须再次手术。
对于短暂性骨髓水肿，减压术可实现完全恢复。在无血管性坏死的I期和II期，成功的结果取决于股骨头的病变大小。小于30%的坏死病变似乎预后最佳。在III期和IV期，不建议进行减压术。
