Effectiveness of multiple small-diameter drilling decompression combined with hip arthroscopy for early osteonecrosis of the femoral head_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Ji ,  LI Zhongli , SU Xiangzheng , LIU Chunhui , ZHANG Hao , WANG Ketao

Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China;

Corresponding author：

LI Zhongli, Email: lizhongli@263.net

Keywords：

Osteonecrosis of the femoral head; multiple small-diameter drilling decompression; hip joint; arthroscopy

DOI：

10.7507/1002-1892.201704126

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Objective To evaluate the effectiveness of multiple small-diameter drilling decompression combined with hip arthroscopy for early oeteonecrosis of the femoral head (ONFH). Methods Between March 2010 and December 2013, 91 patients with early ONFH were treated with the operation of multiple small-diameter drilling decompression combined with hip arthroscopy in 39 cases (53 hips, group A) or with drilling decompression alone in 52 cases (74 hips, group B). The patients in 2 groups had obvious hip pain and limited motion before operation. There was no significant difference in gender, age, etiology, effected side, stage of osteonecrosis, and preoperative Harris score between 2 groups (P>0.05). Results All operations succeeded and all incisions healed by first intention. The operation time was significantly longer in group A [(73.3±10.6) minutes] than in group B [(41.5±7.2) minutes] (t=8.726, P=0.000). Temporary of sciatic nerve apraxia after operation occurred in 2 patients of group A, and no complication occurred in other patients. Patients were followed up 24-52 months (mean, 39.3 months) in group A and 24-48 months (mean, 34.6 months) in group B. At last follow-up, the Harris scores were 83.34±8.76 in group A and 76.61±9.22 in group B, showing significant differences when compared between 2 groups (t=–4.247, P=0.029) and when compared with preoperative values in 2 groups (t=–10.327, P=0.001; t=–8.216, P=0.008). X-ray films showed that the collapse of the femoral head was observed in 6 hips (1 hip at stage Ⅰand 5 hips at stage Ⅱ) in group A, and in 16 hips (4 hips at stageⅠand 12 hips at stage Ⅱ) in group B; and hip arthroplasty was performed. The total effective rates were 88.68% (47/53) in group A and 78.38% (58/74) in group B, respectively; showing significant difference between 2 groups (χ²=5.241, P=0.041). Conclusion Multiple small-diameter drilling decompression combined with hip arthroscopy is effective in pain relief, improvement of hip function, slowing-down the process of femoral head necrosis, delaying the need for total hip arthroplasty in patients with early ONFH.

Citation： LI Ji, LI Zhongli, SU Xiangzheng, LIU Chunhui, ZHANG Hao, WANG Ketao. Effectiveness of multiple small-diameter drilling decompression combined with hip arthroscopy for early osteonecrosis of the femoral head. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(9): 1025-1030. doi: 10.7507/1002-1892.201704126 Copy

1.	刘予豪, 周驰, 陈雷雷, 等. 基于股骨头坏死围塌陷期理论的保髋术式总结. 中国修复重建外科杂志, 2017, 31(8): 1010-1015.
2.	叶奕亨, 陈凯, 金可可, 等. 塌陷前期股骨头坏死的保头手术治疗的进展. 中国骨伤, 2017, 30 (3): 287-292.
3.	Mohanty SP, Singh KA, Kundangar R, et al. Management of non-traumatic avascular necrosis of the femoral head—a comparative analysis of the outcome of multiple small diameter drilling and core decompression with fibular grafting. Musculoskeletal Surgery, 2017, 10(1): 59-66.
4.	赵德伟, 谢辉, 王子华, 等. 带旋股外侧血管升支髂骨瓣转移治疗股骨头缺血性坏死的临床研究. 中华关节外科杂志(电子版), 2017, 11(3): 234-239.
5.	赵永, 崔松体. 闭合髓芯减压治疗股骨头无菌性坏死 22 例临床总结. 中华损伤与修复杂志(电子版), 2011, 6(3): 427-428.
6.	Yin H, Yuan Z, Wang D. Multiple drilling combined with simvastatin versus multiple drilling alone for the treatment of avascular osteonecrosis of the femoral head: 3-year follow-up study. BMC Musculoskelet Disord, 2016, 17(1): 344.
7.	Ellenrieder M, Tischer T, Kreuz PC, et al. Arthroscopically assisted therapy of avascular necrosis of the femoral head. Oper Orthop Traumatol, 2013, 25(1): 85-94.
8.	Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg (Br), 1985, 67(1): 3-9.
9.	李子荣. 股骨头坏死的 ARCO 分期. 中华外科杂志, 1996, 34 (3): 186-187.
10.	Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
11.	Li J, Zhang H, Su XZ, et al. Long-term Outcome of Multiple Small-diameter Drilling Decompression Combined with Hip Arthroscopy versus Drilling Alone for Early Avascular Necrosis of the Femoral Head. Chin Med J (Engl), 2017, 130(12): 1435-1440.
12.	Camp JF, Colwell CW Jr. Core decompression of the femoral head for osteonecrosis. J Bon Joint Surg (Am), 1986, 68(9): 1313-1319.
13.	Brown PJ, Mannava S, Seyler TM, et al. Multiple Small Diameter Drillings Increase Femoral Neck Stability Compared with Single Large Diameter Femoral Head Core Decompression Technique for Avascular Necrosis of the Femoral Head. Surgical Technology International, 2016, ⅩⅩⅨ: 247-254.
14.	Luca Pierannunzii. Endoscopic and Arthroscopic Assistance in Femoral Head Core Decompression. Arthrosc Tech, 2012, 1(2): e225-e230.
15.	杨静, 康鹏德, 沈彬, 等. 小孔径多通道髓芯钻孔减压治疗早中期股骨头坏死.中华骨科杂志, 2010, 30(1): 58-61.
16.	Vlamis J, Karampinas P, Kavroudakis E, et al. The use of core track endoscopy to document accurate decompression of the femoral head. Hip Int, 2014, 24(3): 284-289.
17.	Manenti G, Altobelli S, Pugliese L, et al. The role of imaging in diagnosis and management of femoral head avascular necrosis. Clin Cases Miner Bone Metab, 2015, 12(Suppl 1): 31-38.
18.	Pierannunzii L. Endoscopic and arthroscopic assistance infemoral head core decompression. Arthrosc Tech, 2012, 1(2): e225-230.
19.	侯新民, 吕仁发, 夏桂芳. CT 与 MRI 诊断早期股骨头缺血坏死的多中心对比分析. 中国 CT 和 MRI 杂志, 2015, 13(6): 95-97.【核对文中出处】.
20.	李众利, 王岩, 刘玉杰, 等. 髋关节镜下钻孔减压治疗早期股骨头无菌坏死的初步报告. 中国矫形外科杂志, 2003, 11(24): 1690-1692.
21.	Gupta AK, Frank RM, Harris JD, et al. Arthroscopic-Assisted Core Decompression for Osteonecrosis of the Femoral Head. Arthrosc Tech, 2014, 3(1): e7-e11.
22.	Möckel G, Labs K. Complications in hip arthroscopy and follow-up therapy. Analysis over a 5-year time period with a total of 13,000 cases. Orthopade, 2014, 43(1): 6-15.
23.	Kowalczuk M, Bhandari M, Farrokhyar F, et al. Complications following hip arthroscopy: a systematic review and meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy, 2013, 21(7): 1669-1675.
24.	Simpson J, Sadri H, Villar R. Hip arthroscopy technique and complications. Orthop Traumatol Surg Res, 2010, 96(8 Suppl): S68-S76.
25.	Scher DL, Belmont PJ Jr, Owens BD. Case report: osteonecrosis of the femoral head after hip arthroscopy. Clin Orthop Relat Res; 2010, 468(11): 3121-3125.
26.	王志刚, 王岩, 刘玉杰, 等. 小孔径钻孔减压并髋关节镜清理术治疗早期股骨头缺血性坏死的临床研究. 中华医学杂志, 2007, 87(29): 2041-2044.

1. 刘予豪, 周驰, 陈雷雷, 等. 基于股骨头坏死围塌陷期理论的保髋术式总结. 中国修复重建外科杂志, 2017, 31(8): 1010-1015.
2. 叶奕亨, 陈凯, 金可可, 等. 塌陷前期股骨头坏死的保头手术治疗的进展. 中国骨伤, 2017, 30 (3): 287-292.
3. Mohanty SP, Singh KA, Kundangar R, et al. Management of non-traumatic avascular necrosis of the femoral head—a comparative analysis of the outcome of multiple small diameter drilling and core decompression with fibular grafting. Musculoskeletal Surgery, 2017, 10(1): 59-66.
4. 赵德伟, 谢辉, 王子华, 等. 带旋股外侧血管升支髂骨瓣转移治疗股骨头缺血性坏死的临床研究. 中华关节外科杂志(电子版), 2017, 11(3): 234-239.
5. 赵永, 崔松体. 闭合髓芯减压治疗股骨头无菌性坏死 22 例临床总结. 中华损伤与修复杂志(电子版), 2011, 6(3): 427-428.
6. Yin H, Yuan Z, Wang D. Multiple drilling combined with simvastatin versus multiple drilling alone for the treatment of avascular osteonecrosis of the femoral head: 3-year follow-up study. BMC Musculoskelet Disord, 2016, 17(1): 344.
7. Ellenrieder M, Tischer T, Kreuz PC, et al. Arthroscopically assisted therapy of avascular necrosis of the femoral head. Oper Orthop Traumatol, 2013, 25(1): 85-94.
8. Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg (Br), 1985, 67(1): 3-9.
9. 李子荣. 股骨头坏死的 ARCO 分期. 中华外科杂志, 1996, 34 (3): 186-187.
10. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
11. Li J, Zhang H, Su XZ, et al. Long-term Outcome of Multiple Small-diameter Drilling Decompression Combined with Hip Arthroscopy versus Drilling Alone for Early Avascular Necrosis of the Femoral Head. Chin Med J (Engl), 2017, 130(12): 1435-1440.
12. Camp JF, Colwell CW Jr. Core decompression of the femoral head for osteonecrosis. J Bon Joint Surg (Am), 1986, 68(9): 1313-1319.
13. Brown PJ, Mannava S, Seyler TM, et al. Multiple Small Diameter Drillings Increase Femoral Neck Stability Compared with Single Large Diameter Femoral Head Core Decompression Technique for Avascular Necrosis of the Femoral Head. Surgical Technology International, 2016, ⅩⅩⅨ: 247-254.
14. Luca Pierannunzii. Endoscopic and Arthroscopic Assistance in Femoral Head Core Decompression. Arthrosc Tech, 2012, 1(2): e225-e230.
15. 杨静, 康鹏德, 沈彬, 等. 小孔径多通道髓芯钻孔减压治疗早中期股骨头坏死.中华骨科杂志, 2010, 30(1): 58-61.
16. Vlamis J, Karampinas P, Kavroudakis E, et al. The use of core track endoscopy to document accurate decompression of the femoral head. Hip Int, 2014, 24(3): 284-289.
17. Manenti G, Altobelli S, Pugliese L, et al. The role of imaging in diagnosis and management of femoral head avascular necrosis. Clin Cases Miner Bone Metab, 2015, 12(Suppl 1): 31-38.
18. Pierannunzii L. Endoscopic and arthroscopic assistance infemoral head core decompression. Arthrosc Tech, 2012, 1(2): e225-230.
19. 侯新民, 吕仁发, 夏桂芳. CT 与 MRI 诊断早期股骨头缺血坏死的多中心对比分析. 中国 CT 和 MRI 杂志, 2015, 13(6): 95-97.【核对文中出处】.
20. 李众利, 王岩, 刘玉杰, 等. 髋关节镜下钻孔减压治疗早期股骨头无菌坏死的初步报告. 中国矫形外科杂志, 2003, 11(24): 1690-1692.
21. Gupta AK, Frank RM, Harris JD, et al. Arthroscopic-Assisted Core Decompression for Osteonecrosis of the Femoral Head. Arthrosc Tech, 2014, 3(1): e7-e11.
22. Möckel G, Labs K. Complications in hip arthroscopy and follow-up therapy. Analysis over a 5-year time period with a total of 13,000 cases. Orthopade, 2014, 43(1): 6-15.
23. Kowalczuk M, Bhandari M, Farrokhyar F, et al. Complications following hip arthroscopy: a systematic review and meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy, 2013, 21(7): 1669-1675.
24. Simpson J, Sadri H, Villar R. Hip arthroscopy technique and complications. Orthop Traumatol Surg Res, 2010, 96(8 Suppl): S68-S76.
25. Scher DL, Belmont PJ Jr, Owens BD. Case report: osteonecrosis of the femoral head after hip arthroscopy. Clin Orthop Relat Res; 2010, 468(11): 3121-3125.
26. 王志刚, 王岩, 刘玉杰, 等. 小孔径钻孔减压并髋关节镜清理术治疗早期股骨头缺血性坏死的临床研究. 中华医学杂志, 2007, 87(29): 2041-2044.

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Effectiveness of multiple small-diameter drilling decompression combined with hip arthroscopy for early osteonecrosis of the femoral head

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