骨坏死髓心减压术.pptVIP

Core Decompression for Osteonecrosis of the hip Clin Orthop.2004;418:29-33 DEVELOPMENT OF CORE DECOMPRESSION OFTHE FEMORAL HEAD Core decompression of the hip is the most common pro-cedure currently used to treat the early stages of ON of the femoral head. Ficat and Arlet then hypothesized that ON could be treated successfully by decompressing the femoral head. The goal of core decompression was to decompress the femoral head pressure, restore normal vascular flows, and alleviate pain in the hip.Even though numerous studies have been published no general consensus has been developed regarding patient selection, surgical technique, classification systems used, or postoperative treatment of these patients. CLASSIFICATION AND STAGING The purpose of any classification system is to provide guidelines for treatment and prognosis. Over the years, numerous different classifications systems have been developed to evaluate patients with ON of the femoral head but currently, there is no standard unified classification system used by all investigators. There is general agreement that the prognosis for a patient with ON of the hip is influenced by the extent and the location of the necrotic area in the femoral head and whether there is involvement of the acetabulum. Ficat and Arlet originally developed a four-stage classification system based on radiographic changes and the functional exploration of bone that included intraosseous venography and measurement of bone marrow pressure (Table 1). Since that time, numerous different classification systems have been developed but the University of Pennsylvania System of Classification and Staging has the most potential as a useful clinical and research tool. Because it included MRI evaluations, which allow for the quantification of the extent of femoral head involvement (Table 2). CORE DECOMPRESSION There have been numerous extensive literature reviews published assessing the clinical results of core decompression. Smith et a