Core Decompression for Osteonecrosis of the Femoral Head at Pre-Collapse Stage

股骨頭缺血性壞死之減壓治療

陳崇桓(Chung-Hwan Chen) ； 張瑞根(Je-Ken Chang) ； 黃冠諭(Kuan-Yu Huang) ； 洪韶鴻(Shao-Hung Hung) ； 林高田(Gau-Tyan Lin) ； 林森源(Sen-Yuen Lin)

《The Kaohsiung Journal of Medical Sciences》 16卷2期 (2000/02) Pp. 76-82

https://doi.org/10.6452/KJMS.200002.0076

摘要

我們追蹤從1984年四月至1998年六月因股骨頭缺血性壞死而接受減壓治療之25個病人(27個髖關節)，追蹤治療期間至少一年(平均28個月)。10個髖關節(9個病人)因股骨頭持續塌陷超過2mm或因嚴重疼痛而再次接受開刀而被視為失敗。我們再將這些結果依其壞死之期別與壞死範圍之大小依照Ohzono z 分類，頭部外堤支撐指標(LHI)及Kerboul氏壞死角度做一個研究。依照Ohzono分類，其各個部同期之存活率為：1B：100%，1C：44%，2：25%，3B：0%。在Kerboul氏壞死角度小於250°的髖關節中，除了一個之外，其餘的關節都得到成功的結果。所有Kerboul氏壞死角度超過250°的關節都繼續塌陷而失敗。14(93%)個頭部外堤支撐指標超過20%的髖關節不再塌陷。頭部外堤支撐指標小於12%的髖關節中，只有一個沒有塌陷。所以我們推論減壓手術在早期合併有小的壞死範圍或有好的側邊支撐的股骨頭可得到好的效果。

並列摘要

Twenty-five patients (27 hips) were retrospectively studied for core decompression in the treatment of osteonecrosis of the femoral heads at pre-collapse stage, Ficat and Alert stages I and II, from Apr. 1984 to Jun. 1998 with follow-up period at least 1 yr (mean 28 months). Eleven hips (10 patients) were considered to have failed due to progressive collapsed more than 2mm, severe pain or reoperation. We further analyzed the results with regard to the stages, the size of the necrotic area according to the Ohzono classification, the lateral head index (LHI) and the Kerboul combined necrotic angle. The survival rate according to the Ohzono classification was type IB: 100%, IC: 44%, 2: 25%, and 3B: 0%. Hips with Kerboul angle less than 250° revealed satisfactory results.!n all except one hip. All hips with Kerboul angle more than 250° collapsed. Fourteen of the 15 hips (93%) with lateral head index more than 20% did not collapse and all hips except one (7/8) with LHI less than 12% collapsed. We conclude core decompression yields satisfactory results in osteonecrotic femoral heads at pre-collapse stage and with small necrotic area or good lateral buttress.

並列關鍵字

osteonecrosis ； femoral head ； core decompression