Operative Orthopadie und Traumatologie · 2020
[Modified advanced core decompression (mACD)].
СтатьяНазвание и аннотация: Перевод в очереди
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Landgraeber Stefan, Jäger Marcus
Аннотация
OBJECTIVE: The modified advanced core decompression (mACD) combines the advantages of a low invasive core decompression with maximal removal of osteonecrotic bone and a biologic reconstruction of the resulting bone defect.
INDICATIONS: Avascular (atraumatic) osteonecrosis of the femoral head (ARCO stage II).
CONTRAINDICATIONS: Subchondral fractures (ARCO stage III); advanced osteoarthritis (e.g., ACRO stage IV); persisting risk factors such as high-dose corticoid therapy, chemotherapy, alcohol abuse; open growth plates; history of side effects or intolerance to components of the applied bone substitute; lack of patient compliance; osteomyelitis or other septic conditions.
SURGICAL TECHNIQUE: Supine positioning on the operation table, skin disinfection, and sterile draping. Skin incision and core decompression using a 3.2 mm guide wire. Removal of a bone cylinder from a nonaffected area of the femoral neck using a hollow trephine. Drilling of the osteonecrotic area over the applied wire up to 5 mm to the subchondral bone under fluoroscopy, insertion of an expandable bone knife and removal of the osteonecrotic bone supported by a curette. Bone grafting of the autologous bone into the subchondral defect zone and filling of the drill canal by resorbable bone substitute.
POSTOPERATIVE MANAGEMENT: Bed rest for 24 h, then partial weight bearing (20 kg) on crutches for 2-6 weeks depending on the bone quality in the defect zone and the applied bone substitute.
RESULTS: Midterm superiority (2 years) in hip survival of the mACD over advanced core depression and core depression, especially in ARCO stage II.
INDICATIONS: Avascular (atraumatic) osteonecrosis of the femoral head (ARCO stage II).
CONTRAINDICATIONS: Subchondral fractures (ARCO stage III); advanced osteoarthritis (e.g., ACRO stage IV); persisting risk factors such as high-dose corticoid therapy, chemotherapy, alcohol abuse; open growth plates; history of side effects or intolerance to components of the applied bone substitute; lack of patient compliance; osteomyelitis or other septic conditions.
SURGICAL TECHNIQUE: Supine positioning on the operation table, skin disinfection, and sterile draping. Skin incision and core decompression using a 3.2 mm guide wire. Removal of a bone cylinder from a nonaffected area of the femoral neck using a hollow trephine. Drilling of the osteonecrotic area over the applied wire up to 5 mm to the subchondral bone under fluoroscopy, insertion of an expandable bone knife and removal of the osteonecrotic bone supported by a curette. Bone grafting of the autologous bone into the subchondral defect zone and filling of the drill canal by resorbable bone substitute.
POSTOPERATIVE MANAGEMENT: Bed rest for 24 h, then partial weight bearing (20 kg) on crutches for 2-6 weeks depending on the bone quality in the defect zone and the applied bone substitute.
RESULTS: Midterm superiority (2 years) in hip survival of the mACD over advanced core depression and core depression, especially in ARCO stage II.