针灸-股骨头缺血性坏死的早期治疗重点培训.pptVIP

DEVELOPMENT OF CORE DECOMPRESSION OFTHE 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;;Mont and associates assessed 42 reports in which 1206 hips were treated by core decompression and 819 hips were treated by various nonoperative means. nonoperative treatment was not successful. Only 23% of hips in 21 studies had a satisfactory clinical result when treated nonoperatively. In 24 studies, 65% of the hips treated with core decompression had an overall satisfactory clinical result. Furthermore, when assessing hips treated before collapse, good results were obtained in 71% of the hips treated with core decompression and in 35% of hips treated nonoperatively. ;Stulberg et al compared core decompression alone with conservative treat-ment in a prospective randomized study that included 55 hips. Core decompression was successful in 70% of the hips that were either Ficat Stage I, II, or III. In contrast, there was limited success with nonoperative treatment (Ficat Stage I, 20%; Ficat Stage II, 0%; Ficat Stage III, 10%). It was concluded that core decompression was more effective than nonoperative treatment for patients with early stages of ON. ;Koo and associates did a randomized trial on 71 hips that were treated by core decompression or nonoperatively. Radiographic progression was seen in 72% of the hips treated with core decompression and in 79% of the hips that were treated symptomatically. Seventy-two percent of the hips treated with a core decompression eventually required a THA and 68% of the hips treated symptomatically required a THA. The investigators concluded that there was no significant advantage in the outcome w