COMPREHENSIVE MANAGEMENT OF EARLY STAGE AVASCULAR NECROSIS OF FEMORAL HEAD BY ARTHROSCOPIC MINIMALLY INVASIVE SURGERY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHUO Naiqiang , WAN Yongxian , LU Xiaobo , ZHANG Zhongjie , TAN Meiyun , CHEN Ge.

Department of Orthopedics, Affiliated Hospital of Luzhou Medical College, Luzhou Sichuan, 646000, P.R.China. Corresponding author: LU Xiaobo, E-mail: luxiaobo1963@126.com;

Corresponding author：

Keywords：

Avascular necrosis of the femoral head; Arthroscopy; Core decompression; Bone graft

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

ObjectiveTo evaluate the effectiveness of comprehensive management for early stage avascular necrosis of the femoral head (ANFH) by arthroscopic minimally invasive surgery by comparing with closed core decompression. MethodsBetween January 2007 and March 2010, 28 patients (33 hips) with early stage ANFH were treated with the procedure of arthroscopic core decompression combined with autogenous cancellous bone graft and bone morphogenetic protein (BMP) in 18 cases (21 hips, trial group) or with simple closed core decompression in 10 cases (12 hips, control group). No significant difference was found in gender, age, disease duration, etiology, and staging between 2 groups (P gt; 0.05). ResultsIncision healed primarily in all patients, and no infection occurred. All patients were followed up 2.5 years on average (range, 1-3 years). Pain relief and improvement of hip function were obtained in all patients at 6 months after operation. At last follow-up, the Harris scores were 85.67 ± 4.78 in trial group and 81.33 ± 7.03 in control group, showing significant difference between 2 groups (t= —2.10, P=0.04). Collapse of the femoral head was observed in 1 hip (Ficat stage II) of trial group, and in 2 hips (Ficat stage I ) and 2 hips (Ficat stage II) of control group; hip arthroplasty was performed. Significant difference in total effective rate was found between trial group and control group (95.24% vs. 66.67%; χ2=4.85, P=0.03). ConclusionArthroscopic core decompression combined with autogenous cancellous bone graft and BMP is more effective than traditional closed core decompression for treatment of early stage ANFH in pain relief, improvement of hip function, slowing-down the process of femoral head necrosis, reduction of hip joint replacement by accurate location of the lesions, and thoroughly debridement of necrotic bone.

Citation： ZHUO Naiqiang,WAN Yongxian,LU Xiaobo,ZHANG Zhongjie,TAN Meiyun,CHEN Ge.. COMPREHENSIVE MANAGEMENT OF EARLY STAGE AVASCULAR NECROSIS OF FEMORAL HEAD BY ARTHROSCOPIC MINIMALLY INVASIVE SURGERY. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(9): 1041-1044. doi: Copy

1.	Aldridge JM 3rd, Urbaniak JR．Avascular necrosis of the femoral head: etiology, pathophysiology, classification, and current treatment guidelines．Am J Orthop (Belle Mead NJ), 2004, 33(7): 327-332．.
2.	Lieberman JR, Berry DJ, Mont MA, et al. Osteonecrosis of the hip: management in the 21st century. Instr Course Lect, 2003, 52: 337-355.
3.	von Stechow D, Drees P. Surgical treatment concepts for femoral head necrosis. Orthopade, 2007, 36(5): 451-457.
4.	Mont MA, Jones LC, Hungerford DS. Nontraumatic osteonecrosis of the femoral head: ten years later. J Bone Joint Surg (Am), 2006, 88(5): 1117-1132.
5.	朱伟南, 叶青合. 多孔钽棒治疗股骨头坏死的研究现况. 实用医学杂志, 2011, 27(4): 711-713.
6.	张宏军, 高书图, 胡永成, 等. 髓芯减压联合自体骨髓干细胞移植治疗股骨头坏死的早期临床观察. 中华骨科杂志, 2010, 30(1): 48-52.
7.	Hernigou P, Zilber S, Filippini P, et al. Total THA in adult osteonecrosis related to sickle cell disease. Clin Orthop Relat Res, 2008, 466 (2): 300-308.
8.	朱建辛, 王跃, 邓俊才, 等. 病灶清除后打压植骨联合多孔钽金属棒植入治疗早期股骨头缺血性坏死. 中国修复重建外科杂志, 2011, 25(11): 1335-1338.
9.	赵德伟, 王卫明, 王本杰, 等. 带双血管蒂大转子骨瓣转移治疗股骨头缺血性坏死. 中华显微外科杂志, 2006, 29(3): 167-169.
10.	张克民, 赵德伟. 髓芯减压自体骨髓细胞移植与带血管蒂骨瓣转位治疗股骨头坏死的比较. 中国骨与关节损伤杂志, 2007, 22(1): 16-19.
11.	Mont MA, Marulanda GA, Seyler TM, et al. Core decompression and nonvascularized bone grafting for the treatment of early stage osteonecrosis of the femoral head. Instr Course Lect, 2007, 56: 213-220.
12.	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.
13.	Hungerford DS, Jones LC．Core decompression. Techniques in Orthopaedics, 2008, 23(1): 26-34．.
14.	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.
15.	李亚屏, 赵庆安, 许海平, 等. 关节镜下髓芯减压骨膜骨颗粒移植治疗股骨头坏死. 中国骨与关节损伤杂志, 2007, 22(11): 902-904.
16.	童培建, 金红婷, 何帮剑, 等. 干细胞介入治疗股骨头缺血性坏死的实验研究. 中华骨科杂志, 2010, 30 (6): 600-606.
17.	杨新明, 石蔚, 杜雅坤, 等. 非细胞型组织工程骨联合钛棒微创植入治疗股骨头早期坏死的疗效分析. 中华骨科杂志, 2010, 30(1): 53-57.
18.	康献刚, 王志强. 骨折愈合过程中细胞因子的作用. 中国修复重建外科杂志, 2008, 22(7): 877-879.
19.	田伟, 王澍寰, 荣国威. 积水潭实用骨科学. 北京: 人民卫生出版社, 2008: 291-301.
20.	Song WS, Yoo JJ, Kim YM, et al. Results of multiple drilling compared with those of conventional methods of core decompression. Clin Orthop Relat Res, 2007, (454): 139-146.

1. Aldridge JM 3rd, Urbaniak JR．Avascular necrosis of the femoral head: etiology, pathophysiology, classification, and current treatment guidelines．Am J Orthop (Belle Mead NJ), 2004, 33(7): 327-332．.
2. Lieberman JR, Berry DJ, Mont MA, et al. Osteonecrosis of the hip: management in the 21st century. Instr Course Lect, 2003, 52: 337-355.
3. von Stechow D, Drees P. Surgical treatment concepts for femoral head necrosis. Orthopade, 2007, 36(5): 451-457.
4. Mont MA, Jones LC, Hungerford DS. Nontraumatic osteonecrosis of the femoral head: ten years later. J Bone Joint Surg (Am), 2006, 88(5): 1117-1132.
5. 朱伟南, 叶青合. 多孔钽棒治疗股骨头坏死的研究现况. 实用医学杂志, 2011, 27(4): 711-713.
6. 张宏军, 高书图, 胡永成, 等. 髓芯减压联合自体骨髓干细胞移植治疗股骨头坏死的早期临床观察. 中华骨科杂志, 2010, 30(1): 48-52.
7. Hernigou P, Zilber S, Filippini P, et al. Total THA in adult osteonecrosis related to sickle cell disease. Clin Orthop Relat Res, 2008, 466 (2): 300-308.
8. 朱建辛, 王跃, 邓俊才, 等. 病灶清除后打压植骨联合多孔钽金属棒植入治疗早期股骨头缺血性坏死. 中国修复重建外科杂志, 2011, 25(11): 1335-1338.
9. 赵德伟, 王卫明, 王本杰, 等. 带双血管蒂大转子骨瓣转移治疗股骨头缺血性坏死. 中华显微外科杂志, 2006, 29(3): 167-169.
10. 张克民, 赵德伟. 髓芯减压自体骨髓细胞移植与带血管蒂骨瓣转位治疗股骨头坏死的比较. 中国骨与关节损伤杂志, 2007, 22(1): 16-19.
11. Mont MA, Marulanda GA, Seyler TM, et al. Core decompression and nonvascularized bone grafting for the treatment of early stage osteonecrosis of the femoral head. Instr Course Lect, 2007, 56: 213-220.
12. 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.
13. Hungerford DS, Jones LC．Core decompression. Techniques in Orthopaedics, 2008, 23(1): 26-34．.
14. 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.
15. 李亚屏, 赵庆安, 许海平, 等. 关节镜下髓芯减压骨膜骨颗粒移植治疗股骨头坏死. 中国骨与关节损伤杂志, 2007, 22(11): 902-904.
16. 童培建, 金红婷, 何帮剑, 等. 干细胞介入治疗股骨头缺血性坏死的实验研究. 中华骨科杂志, 2010, 30 (6): 600-606.
17. 杨新明, 石蔚, 杜雅坤, 等. 非细胞型组织工程骨联合钛棒微创植入治疗股骨头早期坏死的疗效分析. 中华骨科杂志, 2010, 30(1): 53-57.
18. 康献刚, 王志强. 骨折愈合过程中细胞因子的作用. 中国修复重建外科杂志, 2008, 22(7): 877-879.
19. 田伟, 王澍寰, 荣国威. 积水潭实用骨科学. 北京: 人民卫生出版社, 2008: 291-301.
20. Song WS, Yoo JJ, Kim YM, et al. Results of multiple drilling compared with those of conventional methods of core decompression. Clin Orthop Relat Res, 2007, (454): 139-146.

Chinese Journal of Reparative and Reconstructive Surgery

COMPREHENSIVE MANAGEMENT OF EARLY STAGE AVASCULAR NECROSIS OF FEMORAL HEAD BY ARTHROSCOPIC MINIMALLY INVASIVE SURGERY

Abstract Full text Figures/Tables Video References Cited by

Format

Content