现代技术是否提高股骨头坏死钻孔减压的疗效

Do Modern Techniques Improve Core Decompression Outcomes for Hip Osteonecrosis ?,2011-09-13,Content Introduction,Journal : Clin Orthop Relat Res IF: 2.116Published year: 2008 Author: From Sinai Hospital of Baltimore USASystematic Review,Abstract,Object: to determine whether the efficacy improved during the last 15 years Method: 1.compared the success rates before 1992 VS 1992-2007 2.evaluated the outcomes of our 52 patients (79 hips) treated with multiple small-diameter drillings.Result: 1.decrease in additional surgeries and increase in radiographic success 2.small lesions and Ficat Stage I had the best results with 79% no radiographic progressionConclusion: core decompression is a safe and effective procedure,Questions,1.whether the efficacy of core decompression has improved during the last 15 years ?2.whether modern techniques provide better outcomes than those non-operative treatment ?3.whether the outcomes treated using small-diameter drilling were similar to other modern studies ?4.whether patients less radiographic progression and smaller lesion sizes using small diameter drilling would be less likely to have poor outcomes ?,Inclusion criteria,1.provided radiographic outcomes and/or indicated whether patients underwent additional surgeries 2.Only the most recent studies were included at multiple times at different followups3.the use of ancillary cancellous bone grafting4.previously unpublished results at our institution treated using a small-diameter drilling,Exclusion criteria,1.not provide sufficient data to analyze outcomes2.fewer than 10 patients3.Patients younger than 18 years old4.used long cortical strut bone grafting or vascularized bone grafting5.a mean followup of less than 18 months,Criteria for assessing effectiveness,Pre-1992 studies (23),1992 to 2007 studies (26),historical VS modern studies,Nonoperative treatment (18),Multiple small-diameter drilling VS other studies,Results-1,the success rates were higher for the studies during the last 15 years compared to before 1992 1.Without additional surgery from 59% to 70% (p0.001)2.radiographic success increased from 56% to 63% (p0.05)3. fewer patients who were Ficat Stage III after 1992 (p0.001),Results-2,higher proportions of failures nonoperative treatment VS the core decompression studies from 1992 to 20071. underwent surgery at a mean of 67%VS30% (p0.001)2. radiographic failure rates at 72% VS37% (p0.001),Results-3,the small-diameter drilling technique results similar to other studies of the last 15 yearshigher Ficat stages and larger lesion sizes had increased failure ratespatients who had small lesions and Ficat Stage I with 79% of these hips showing no radiographic stage progression,Limits of the study,the small numbers of patients in many of the reports it was difficult to determine when the core decompressions were performed to stratify the study only midterm mean followups (range, 18 months to 144 months), and the long-term outcome is unclearthe level of evidence for the scientific literaturelack of prospective randomized multicenter studies,Conclusions,Recent techniques provide better clinical scores or radiographic outcomes than pre-1992 studies.However, it is unclear whether this improvement is due to improved patient selection or surgical technique.Core decompression is a safe and effective procedure for the early stages of ONFH.We will use core decompression to treat patients who have early small- and medium-sized lesions and are Ficat Stage I or II.,advantages for the small-diameter drilling,(1) more easily reach the anterior portion of the femoral head, (2) there is minimal morbidity; (3) reduced the risk of weakening or penetrating the femoral head and injuring the articular cartilage (4) reduced the risk of stress risers that can lead to a subtrochanteric fracture,Learning exeperience,1. the success rates were higher for the studies during the last 15 years compared to before 1992 whether this improvement is due to improved patient selection or surgical technique.2. higher proportions