Effectiveness of multiple small-diameter drilling decompression combined with hip arthroscopy for early osteonecrosis of the femoral head_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Ji ,  LI Zhongli , SU Xiangzheng , LIU Chunhui , ZHANG Hao , WANG Ketao

Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China;

Corresponding?author：

LI Zhongli, Email: lizhongli@263.net

Keywords：

Osteonecrosis of the femoral head; multiple small-diameter drilling decompression; hip joint; arthroscopy

DOI：

10.7507/1002-1892.201704126

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Objective To evaluate the effectiveness of multiple small-diameter drilling decompression combined with hip arthroscopy for early oeteonecrosis of the femoral head (ONFH). Methods Between March 2010 and December 2013, 91 patients with early ONFH were treated with the operation of multiple small-diameter drilling decompression combined with hip arthroscopy in 39 cases (53 hips, group A) or with drilling decompression alone in 52 cases (74 hips, group B). The patients in 2 groups had obvious hip pain and limited motion before operation. There was no significant difference in gender, age, etiology, effected side, stage of osteonecrosis, and preoperative Harris score between 2 groups (P>0.05). Results All operations succeeded and all incisions healed by first intention. The operation time was significantly longer in group A [(73.3±10.6) minutes] than in group B [(41.5±7.2) minutes] (t=8.726, P=0.000). Temporary of sciatic nerve apraxia after operation occurred in 2 patients of group A, and no complication occurred in other patients. Patients were followed up 24-52 months (mean, 39.3 months) in group A and 24-48 months (mean, 34.6 months) in group B. At last follow-up, the Harris scores were 83.34±8.76 in group A and 76.61±9.22 in group B, showing significant differences when compared between 2 groups (t=–4.247, P=0.029) and when compared with preoperative values in 2 groups (t=–10.327, P=0.001; t=–8.216, P=0.008). X-ray films showed that the collapse of the femoral head was observed in 6 hips (1 hip at stage Ⅰand 5 hips at stage Ⅱ) in group A, and in 16 hips (4 hips at stageⅠand 12 hips at stage Ⅱ) in group B; and hip arthroplasty was performed. The total effective rates were 88.68% (47/53) in group A and 78.38% (58/74) in group B, respectively; showing significant difference between 2 groups (χ²=5.241, P=0.041). Conclusion Multiple small-diameter drilling decompression combined with hip arthroscopy is effective in pain relief, improvement of hip function, slowing-down the process of femoral head necrosis, delaying the need for total hip arthroplasty in patients with early ONFH.

Citation： LI Ji, LI Zhongli, SU Xiangzheng, LIU Chunhui, ZHANG Hao, WANG Ketao. Effectiveness of multiple small-diameter drilling decompression combined with hip arthroscopy for early osteonecrosis of the femoral head. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(9): 1025-1030. doi: 10.7507/1002-1892.201704126 Copy

1.	劉予豪, 周馳, 陳雷雷, 等. 基于股骨頭壞死圍塌陷期理論的保髖術式總結. 中國修復重建外科雜志, 2017, 31(8): 1010-1015.
2.	葉奕亨, 陳凱, 金可可, 等. 塌陷前期股骨頭壞死的保頭手術治療的進展. 中國骨傷, 2017, 30 (3): 287-292.
3.	Mohanty SP, Singh KA, Kundangar R, et al. Management of non-traumatic avascular necrosis of the femoral head—a comparative analysis of the outcome of multiple small diameter drilling and core decompression with fibular grafting. Musculoskeletal Surgery, 2017, 10(1): 59-66.
4.	趙德偉, 謝輝, 王子華, 等. 帶旋股外側血管升支髂骨瓣轉移治療股骨頭缺血性壞死的臨床研究. 中華關節外科雜志(電子版), 2017, 11(3): 234-239.
5.	趙永, 崔松體. 閉合髓芯減壓治療股骨頭無菌性壞死 22 例臨床總結. 中華損傷與修復雜志(電子版), 2011, 6(3): 427-428.
6.	Yin H, Yuan Z, Wang D. Multiple drilling combined with simvastatin versus multiple drilling alone for the treatment of avascular osteonecrosis of the femoral head: 3-year follow-up study. BMC Musculoskelet Disord, 2016, 17(1): 344.
7.	Ellenrieder M, Tischer T, Kreuz PC, et al. Arthroscopically assisted therapy of avascular necrosis of the femoral head. Oper Orthop Traumatol, 2013, 25(1): 85-94.
8.	Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg (Br), 1985, 67(1): 3-9.
9.	李子榮. 股骨頭壞死的 ARCO 分期. 中華外科雜志, 1996, 34 (3): 186-187.
10.	Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
11.	Li J, Zhang H, Su XZ, et al. Long-term Outcome of Multiple Small-diameter Drilling Decompression Combined with Hip Arthroscopy versus Drilling Alone for Early Avascular Necrosis of the Femoral Head. Chin Med J (Engl), 2017, 130(12): 1435-1440.
12.	Camp JF, Colwell CW Jr. Core decompression of the femoral head for osteonecrosis. J Bon Joint Surg (Am), 1986, 68(9): 1313-1319.
13.	Brown PJ, Mannava S, Seyler TM, et al. Multiple Small Diameter Drillings Increase Femoral Neck Stability Compared with Single Large Diameter Femoral Head Core Decompression Technique for Avascular Necrosis of the Femoral Head. Surgical Technology International, 2016, ⅩⅩⅨ: 247-254.
14.	Luca Pierannunzii. Endoscopic and Arthroscopic Assistance in Femoral Head Core Decompression. Arthrosc Tech, 2012, 1(2): e225-e230.
15.	楊靜, 康鵬德, 沈彬, 等. 小孔徑多通道髓芯鉆孔減壓治療早中期股骨頭壞死.中華骨科雜志, 2010, 30(1): 58-61.
16.	Vlamis J, Karampinas P, Kavroudakis E, et al. The use of core track endoscopy to document accurate decompression of the femoral head. Hip Int, 2014, 24(3): 284-289.
17.	Manenti G, Altobelli S, Pugliese L, et al. The role of imaging in diagnosis and management of femoral head avascular necrosis. Clin Cases Miner Bone Metab, 2015, 12(Suppl 1): 31-38.
18.	Pierannunzii L. Endoscopic and arthroscopic assistance infemoral head core decompression. Arthrosc Tech, 2012, 1(2): e225-230.
19.	侯新民, 呂仁發, 夏桂芳. CT 與 MRI 診斷早期股骨頭缺血壞死的多中心對比分析. 中國 CT 和 MRI 雜志, 2015, 13(6): 95-97.【核對文中出處】.
20.	李眾利, 王巖, 劉玉杰, 等. 髖關節鏡下鉆孔減壓治療早期股骨頭無菌壞死的初步報告. 中國矯形外科雜志, 2003, 11(24): 1690-1692.
21.	Gupta AK, Frank RM, Harris JD, et al. Arthroscopic-Assisted Core Decompression for Osteonecrosis of the Femoral Head. Arthrosc Tech, 2014, 3(1): e7-e11.
22.	M?ckel G, Labs K. Complications in hip arthroscopy and follow-up therapy. Analysis over a 5-year time period with a total of 13,000 cases. Orthopade, 2014, 43(1): 6-15.
23.	Kowalczuk M, Bhandari M, Farrokhyar F, et al. Complications following hip arthroscopy: a systematic review and meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy, 2013, 21(7): 1669-1675.
24.	Simpson J, Sadri H, Villar R. Hip arthroscopy technique and complications. Orthop Traumatol Surg Res, 2010, 96(8 Suppl): S68-S76.
25.	Scher DL, Belmont PJ Jr, Owens BD. Case report: osteonecrosis of the femoral head after hip arthroscopy. Clin Orthop Relat Res; 2010, 468(11): 3121-3125.
26.	王志剛, 王巖, 劉玉杰, 等. 小孔徑鉆孔減壓并髖關節鏡清理術治療早期股骨頭缺血性壞死的臨床研究. 中華醫學雜志, 2007, 87(29): 2041-2044.

1. 劉予豪, 周馳, 陳雷雷, 等. 基于股骨頭壞死圍塌陷期理論的保髖術式總結. 中國修復重建外科雜志, 2017, 31(8): 1010-1015.
2. 葉奕亨, 陳凱, 金可可, 等. 塌陷前期股骨頭壞死的保頭手術治療的進展. 中國骨傷, 2017, 30 (3): 287-292.
3. Mohanty SP, Singh KA, Kundangar R, et al. Management of non-traumatic avascular necrosis of the femoral head—a comparative analysis of the outcome of multiple small diameter drilling and core decompression with fibular grafting. Musculoskeletal Surgery, 2017, 10(1): 59-66.
4. 趙德偉, 謝輝, 王子華, 等. 帶旋股外側血管升支髂骨瓣轉移治療股骨頭缺血性壞死的臨床研究. 中華關節外科雜志(電子版), 2017, 11(3): 234-239.
5. 趙永, 崔松體. 閉合髓芯減壓治療股骨頭無菌性壞死 22 例臨床總結. 中華損傷與修復雜志(電子版), 2011, 6(3): 427-428.
6. Yin H, Yuan Z, Wang D. Multiple drilling combined with simvastatin versus multiple drilling alone for the treatment of avascular osteonecrosis of the femoral head: 3-year follow-up study. BMC Musculoskelet Disord, 2016, 17(1): 344.
7. Ellenrieder M, Tischer T, Kreuz PC, et al. Arthroscopically assisted therapy of avascular necrosis of the femoral head. Oper Orthop Traumatol, 2013, 25(1): 85-94.
8. Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg (Br), 1985, 67(1): 3-9.
9. 李子榮. 股骨頭壞死的 ARCO 分期. 中華外科雜志, 1996, 34 (3): 186-187.
10. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
11. Li J, Zhang H, Su XZ, et al. Long-term Outcome of Multiple Small-diameter Drilling Decompression Combined with Hip Arthroscopy versus Drilling Alone for Early Avascular Necrosis of the Femoral Head. Chin Med J (Engl), 2017, 130(12): 1435-1440.
12. Camp JF, Colwell CW Jr. Core decompression of the femoral head for osteonecrosis. J Bon Joint Surg (Am), 1986, 68(9): 1313-1319.
13. Brown PJ, Mannava S, Seyler TM, et al. Multiple Small Diameter Drillings Increase Femoral Neck Stability Compared with Single Large Diameter Femoral Head Core Decompression Technique for Avascular Necrosis of the Femoral Head. Surgical Technology International, 2016, ⅩⅩⅨ: 247-254.
14. Luca Pierannunzii. Endoscopic and Arthroscopic Assistance in Femoral Head Core Decompression. Arthrosc Tech, 2012, 1(2): e225-e230.
15. 楊靜, 康鵬德, 沈彬, 等. 小孔徑多通道髓芯鉆孔減壓治療早中期股骨頭壞死.中華骨科雜志, 2010, 30(1): 58-61.
16. Vlamis J, Karampinas P, Kavroudakis E, et al. The use of core track endoscopy to document accurate decompression of the femoral head. Hip Int, 2014, 24(3): 284-289.
17. Manenti G, Altobelli S, Pugliese L, et al. The role of imaging in diagnosis and management of femoral head avascular necrosis. Clin Cases Miner Bone Metab, 2015, 12(Suppl 1): 31-38.
18. Pierannunzii L. Endoscopic and arthroscopic assistance infemoral head core decompression. Arthrosc Tech, 2012, 1(2): e225-230.
19. 侯新民, 呂仁發, 夏桂芳. CT 與 MRI 診斷早期股骨頭缺血壞死的多中心對比分析. 中國 CT 和 MRI 雜志, 2015, 13(6): 95-97.【核對文中出處】.
20. 李眾利, 王巖, 劉玉杰, 等. 髖關節鏡下鉆孔減壓治療早期股骨頭無菌壞死的初步報告. 中國矯形外科雜志, 2003, 11(24): 1690-1692.
21. Gupta AK, Frank RM, Harris JD, et al. Arthroscopic-Assisted Core Decompression for Osteonecrosis of the Femoral Head. Arthrosc Tech, 2014, 3(1): e7-e11.
22. M?ckel G, Labs K. Complications in hip arthroscopy and follow-up therapy. Analysis over a 5-year time period with a total of 13,000 cases. Orthopade, 2014, 43(1): 6-15.
23. Kowalczuk M, Bhandari M, Farrokhyar F, et al. Complications following hip arthroscopy: a systematic review and meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy, 2013, 21(7): 1669-1675.
24. Simpson J, Sadri H, Villar R. Hip arthroscopy technique and complications. Orthop Traumatol Surg Res, 2010, 96(8 Suppl): S68-S76.
25. Scher DL, Belmont PJ Jr, Owens BD. Case report: osteonecrosis of the femoral head after hip arthroscopy. Clin Orthop Relat Res; 2010, 468(11): 3121-3125.
26. 王志剛, 王巖, 劉玉杰, 等. 小孔徑鉆孔減壓并髖關節鏡清理術治療早期股骨頭缺血性壞死的臨床研究. 中華醫學雜志, 2007, 87(29): 2041-2044.

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Effectiveness of multiple small-diameter drilling decompression combined with hip arthroscopy for early osteonecrosis of the femoral head

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