股骨头钻孔液氮冷冻法建立山羊股骨头坏死模型

[目的]研究通过股骨头钻孔液氮冷冻法建立山羊股骨头坏死模型。[方法]12只山羊24髋随机法分配为实验组、对照组。实验组山羊采用股骨头钻孔液氮冷冻灌注法灌注山羊股骨头,对照组山羊采用股骨头钻孔灌注生理盐水法,术后80万IU青霉素连续抗感染3 d,干预2周后行影像学检查,分别行X线、三维CT、大体标本、组织学(HE染色)观察骨结构改变及空骨陷窝率,空骨陷窝率超过50%定义为骨坏死。[结果]山羊手术后完全苏醒后可完全负重站立行走。术后3 d山羊活动、饮食恢复至术前水平。术后山羊伤口干燥,未见明显渗血渗液以及炎症反应等。术后2周山羊X线及三维CT示:实验组股骨头骨小梁稀疏、钻孔通道周围可见明显骨质硬化;对照组骨小梁正常,钻孔通道周围未见骨质硬化。处死山羊后实验组与对照组标本大体形态未见明显改变,但实验组股骨头关节面软骨颜色变暗、光泽度下降。组织切片HE染色提示对照组空骨陷窝率(11.3±1.6)%<50%,实验组空骨陷窝率(59.2±5.2)%>50%,空骨陷窝率实验组明显高于对照组(P<0.05)。股骨头坏死造模成功率91.67%(11/12)。[结论]股骨头钻孔液氮冷冻法可以成功建立山羊股骨头坏死模型,此法安全、简单易行、周期短、造模成功率高,为进一步研究股骨头坏死保头治疗提供有力的途径。     

Precision of computer-assisted core decompression drilling of the femoral head

INTRODUCTION: Osteonecrosis of the femoral head is a local destructive disease with progression into devastating stages. Left untreated it mostly leads to severe secondary osteoarthrosis and early endoprosthetic joint replacement. Core decompression by exact drilling into the ischemic areas can be performed in early stages according to Ficat or ARCO. Computer-aided surgery might enhance the precision of the drilling and lower the radiation exposure time of both staff and patients. The aim of this study was to evaluate the precision of the fluoroscopically based VectorVision navigation system in an in vitro model. MATERIALS AND METHODS: Thirty sawbones were prepared with a defect filled up with a radiopaque gypsum sphere mimicking the osteonecrosis. Twenty sawbones were drilled by guidance of an intraoperative navigation system VectorVision (BrainLAB, Munich, Germany) and 10 sawbones by fluoroscopic control only. RESULTS: No gypsum sphere was missed. There was a statistically significant difference regarding the three-dimensional deviation (Euclidian norm) as well as maximum deviation in x-, y- or z-direction (maximum norm) to the desired mid-point of the lesion, with a mean of 0.51 and 0.4 mm in the navigated group and 1.1 and 0.88 mm in the control group, respectively. Furthermore, significant difference was found in the number of drilling corrections as well as the radiation time needed: no second drilling or correction of drilling direction was necessary in the navigated group compared to 1.4 in the control group. The radiation time needed was less than 1 s compared to 3.1 s, respectively. CONCLUSION: The fluoroscopy-based VectorVision navigation system shows a high feasibility of computer-guided drilling with a clear reduction of radiation exposure time and can therefore be integrated into clinical routine. The additional time needed is acceptable regarding the simultaneous reduction of radiation time.     

Evaluation of a pig femoral head osteonecrosis model

Background  

A major cause of osteonecrosis of the femoral head is interruption of a blood supply to the proximal femur. In order to evaluate blood circulation and pathogenetic alterations, a pig femoral head osteonecrosis model was examined to address whether ligature of the femoral neck (vasculature deprivation) induces a reduction of blood circulation in the femoral head, and whether transphyseal vessels exist for communications between the epiphysis and the metaphysis. We also tested the hypothesis that the vessels surrounding the femoral neck and the ligamentum teres represent the primary source of blood flow to the femoral head.     

股骨头钻孔药物灌注治疗股骨头坏死

目的研究股骨头钻孔蝮蛇抗栓酶和丹参局部灌注对股骨头缺血坏死的治疗作用。方法对３８例４１髋股骨头缺血性坏死（Ⅰ－Ⅳ期）患者采用股骨头钻孔减夺，然后置管灌注蝮蛇栓酶和丹参，观察髋关节疼痛，功能恢复、活动度、股骨头修复情况。结果疗效评价根据１９９５年全国首届骨示死学术交流会拟定的１００分标准，优１５例１７髋，良２０例２１髋，可２例２髋，差１例１髋。总优良率９２％。结论股骨头钻孔药物灌注治疗股骨头坯 有手     

Zoledronic acid improves femoral head sphericity in a rat model of perthes disease.

We hypothesized that the bisphosphonate zoledronic acid (ZA) could improve femoral head sphericity in Perthes disease by changing the balance between bone resorption and new bone formation. This study tests the effect of ZA in an established model of Perthes disease, the spontaneously hypertensive rat (SHR). One hundred and twenty 4-week old SHR rats were divided into three groups of 40: saline monthly, 0.015 mg/kg ZA weekly, or 0.05 mg/kg ZA monthly. At 15 weeks DXA measurements documented that femoral head BMD was increased by 18% in ZA weekly and 21% in ZA monthly compared to controls (p<0.01). Femoral head sphericity in animals with osteonecrosis was improved in ZA-treatment groups (p<0.01) as measured by epiphyseal quotient (EQ). The proportion of "flat" heads (EQ0.40) was significantly reduced from 32% in saline-treated animals to 12% in weekly ZA and 3% in monthly ZA (p<0.01). Histologically there was a similar prevalence of osteonecrosis in all groups. The prevalence of ossification delay was significantly reduced by ZA treatment (p<0.01). Zoledronic acid favorably altered femoral head shape in this spontaneous model of osteonecrosis in growing rats. Translation of these results to Perthes disease could mean that deformity of the femoral head may be modified in children, perhaps reducing the need for surgical intervention in childhood and adult life.     

Treatment of osteonecrosis of the femoral head by drilling and muscle-pedicle bone grafting

Sixty-one patients with 68 osteonecrotic femoral heads, at different stages of development, were treated surgically; their average age was 36 years. Necrosis followed a fracture in 43 hips and traumatic dislocation in three. It was idiopathic in 14, cortisone-induced in seven and associated with gout in one. The operation of multiple drilling, curettage of the necrotic bone and muscle pedicle bone grafting was performed in all. Cheilectomy of the superolateral part of the femoral head and adductor tenotomy were added in cases of advanced necrosis. Of the several types of muscle pedicle used, tensor fasciae latae anteriorly and quadratus femoris posteriorly were preferred. Full weight-bearing was not permitted for five to six months. The follow-up period varied from three to 12 years. Hip pain was regularly relieved and abduction and rotation of the joints were improved. Those with post-traumatic or idiopathic necrosis did better than those with cortisone-induced necrosis.     

Core decompression of the femoral head for osteonecrosis using percutaneous multiple small-diameter drilling

Osteonecrosis is a disease with a wide ranging etiology and poorly understood pathogenesis seen commonly in young patients. Core decompression has historically been used in patients with small-sized or medium-sized precollapse lesions in an attempt to forestall disease progression. Typically, an 8-10 mm wide cannula trephine is used to do this procedure. The authors report on a new technique using multiple small drillings with a 3-mm Steinman pin to effectuate the core decompression. In this report, there were 32 of 45 hips (71%; 35 patients) with a successful clinical result at a mean followup of 2 years (range, 20-39 months). Twenty four of 30 Stage I hips (80%; 23 patients) had successful outcomes compared with 8 of 15 Stage II hips (57%; 12 patients) with no surgical complications occurring with this technique. This procedure is technically straightforward and led to minimal morbidity with no surgical complications. It may be effective in delaying the need for total hip arthroplasty in young patients with early (precollapse) stages of femoral head osteonecrosis.     

Osteonecrosis of the femoral head.

New cases of osteonecrosis of the femoral head in the United States number between 10,000 and 20,000 per year. This disease usually affects patients in their late 30s and early 40s. Although a number of authors have related specific risk factors to this disease, its etiology, pathogenesis, and treatment remain a source of considerable controversy. This disorder has been associated with corticosteroid use, substance abuse, and various systemic medical conditions. Either direct damage to osteocytes (e.g., by toxin production) or indirect damage (e.g., due to disorders in fat metabolism or hypoxia) may lead to osteonecrosis. Patients at increased risk for osteonecrosis should be monitored closely. Unfortunately, most cases are diagnosed in an advanced stage of disease, when minimally invasive surgical procedures are no longer helpful. Furthermore, patients in the advanced stage of the disease must undergo total hip replacement at a young age, which carries a poor long-term prognosis.     

Percutaneously drilling through femoral head and neck fenestration combining with compacted autograft for early femoral head necrosis: A retrospective study

Background

The purpose of this study was to evaluate the clinical results, survivorship and quick rehabilitation effects of modified surgery of percutaneously drilling and decompression through femoral head and neck fenestration combined with compacted autograft for early femoral head necrosis.

小孔径多通道髓芯钻孔减压治疗早中期股骨头坏死

目的 回顾性分析小孔径多通道髓芯钻孔减压技术治疗股骨头坏死.并探讨其疗效及适应证.方法 2000年3月至2004年12月,共55例(85髋)早期股骨头坏死患者行股骨头髓芯减压术.所有病例入院时均按宾夕法尼亚大学分期法分期并行患髋Harris评分.所有患者均在"C"型臂X线机透视下采用直径3.2 mm空心环钻经大转子下向股骨头外上钻孔,平行3个通道钻孔减压.术后1、2、3、6个月门诊随访,以后每年门诊随访至少1次.随访观察比较患髋Harris评分变化,影像学进展及是否行人工髋关节置换术.术后评价:股骨头塌陷视为钻孔减压失败,疼痛缓解、股骨头未塌陷视为有效.结果 49例(79髋)患者获得随访,术后平均随访4.8(3.5-9.2)年.Ⅰ C期11髋,Harris评分由术前平均75分提高到末次随访时85分,1例(1个股骨头)术后1年发生塌陷;Ⅱ A期15髋,Harris评分由术前平均75分提高到85分,3例(3个股骨头)分别于术后1、2年发生塌陷;Ⅱ B期24髋,Harris评分由术前平均72分提高到83分,5例(6个股骨头)分别于术后1、2、4年发生塌陷;Ⅱ C期29髋,Harris评分由术前平均73分提高到82分,7例(9个股骨头)分别于术后1、2、3年发生塌陷.所有患者术后1个月疼痛均明显缓解,无明显手术并发症发生.结论 小孔径多通道髓芯钻孔减压技术治疗早中期、轻中度股骨头坏死,具有良好的近中期疗效,而且无明显手术并发症.     

Computer-assisted femoral head resurfacing.

Femoral head resurfacing is re-emerging as a surgical option for younger patients who are not yet candidates for total hip replacement. However, this procedure is more difficult than total hip replacement, and the mechanical jigs typically used to align the implant produce significant variability in implant placement and take a significant amount of time to position properly. We propose that a computer-assisted surgical (CAS) technique could reduce implant variability with little or no increase in operative time. We describe a new CAS technique for this procedure and demonstrate in a cadaver study of five paired femurs that the CAS technique in the hands of a novice surgeon markedly reduced the varus/valgus variability of the implant relative to the pre-operative plan (2 degrees standard deviation for CAS versus 5 degrees for a mechanical jig operated by an expert surgeon). We also show that the mechanical jig resulted in significantly retroverted implant placement. There was no significant difference in operative time between the two techniques.     

A new preclinical femoral head osteonecrosis model in sheep

Introduction  

Animal models have been used as insight into the pathogenesis of osteonecrosis, even though most have failed to reproduce all stages of human disease, limiting progression in experimental treatment modalities. A new surgically induced animal model of femoral head osteonecrosis in sheep is presented.     

Treatment of post-traumatic avascular necrosis of the femoral head by multiple drilling and muscle-pedicle bone grafting. Preliminary report

Twenty-nine patients with avascular necrosis of the femoral head after injury have been treated by operation. Multiple drilling of the femoral head was performed, necrotic bone removed and a muscle-pedicle bone graft implanted into the head and neck of the femur. In 17 of the patients the necrosis was associated with an un-united femoral neck fracture, in 11 it occurred after the fracture had united, and one case followed reduction of a dislocated hip. The hips became painless soon after operation. The patients were young (average age 35 years), and full weight-bearing was not allowed for several months. The follow-up period ranged from 22 to 64 months. The results were excellent in 20 patients, good in five, fair in three and poor in one.     

Osteophytes and the osteoarthritic femoral head.

The study describes the topography, morphology and growth of osteophytes in forty femoral heads removed from patients presenting with advanced osteoarthritis of the hip. In addition to standard histological techniques, radiography of serial bone slices in vivo bone labelling with tetracycline and 32P were used. The pattern of major osteophyte formation appeared to be influenced by the direction, degree and rate of displacement of the femoral head in relation to the acetabulum; four principal patterns of growth were noted. Osteophytes form part of extensive osteogenic processes that involve bone structure in the osteoarthritic joint.     

Long-term result after femoral head substitution in postinfectious aplasia of the femoral head

Purpose  

This case report presents a new and unique surgical greater trochanter split procedure for reconstructing a hip joint after an infantile hip sepsis with consequent aplasia of the femoral head.     

Ischemic necrosis of the femoral head: An experimental rabbit model

To describe the morphology of the proximal femoral epiphysis in a rabbit model from the ischemic insult to the end of the revascularization process. Ischemia of the femoral head was induced in 32 rabbits at the 8th day of life, by sectioning the joint capsule and the ligamentum teres and dislocating the femoral head. Rabbits were sacrificed at 4, 8, 12, 18, 21, 26, 34, and 48 days after surgery and femoral heads were observed histologically. During the first days following the ischemic injury, large areas underwent necrotic changes. Both epiphyseal and physeal cartilage were thicker than normal and less trabecular bone formation was evident. Bone marrow was also diffusely necrotic within the secondary center of ossification. After day 12th, reparative process started with formation of extensive areas of fibrocartilage and several secondary centers of ossifications. At that stage femoral head deformity was already evident. In the following days the secondary centers of ossification cohalesced and epiphyseal and physeal cartilage resumed a normal appearance, but the femur showed a permanent deformity. In newborn rabbits, the ischemic injury to the femoral head blocked the ossification of the epiphyseal and physeal cartilage associated to necrotic bone marrow within the secondary center of ossification of the femoral head as well as to extensive areas of necrosis of epiphyseal and physeal cartilage. Extensive areas of fibrocartilage and small newly formed ossification centers within the femoral epiphysis were the results of the revascularization process, and femoral head deformity became stable afterward. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:535–541, 2015.     

基于股骨头坏死数据库分析激素性股骨头坏死的发病特征

目的分析激素性股骨头坏死的发病特征,为激素性股骨头坏死的早期预防和诊断提供参考。方法利用股骨头坏死数据库,回顾性分析2014年1月至2017年12月住院治疗的激素性股骨头坏死患者,提取患者的基本信息(性别、年龄、职业、文化程度、BMI值)、疾病情况(发病部位、病程、严重程度、中医证型、首次就诊医院等级)、使用激素情况(原发病、使用时间、药品名称、药物方法、每日使用量、每日使用次数)等相关资料进行归纳分析。结果共纳入股骨头坏死患者1 062例,其中激素性股骨头坏死患者471例,最终纳入438例。激素性股骨头坏死的发病特征为:(1)患者主要基本情况:女性271例(61.87%);年龄在51～60岁的患者223例(50.91%);职业为农民的患者224例(51.14%);初中文化程度的患者123例(28.08%); BMI值大多在正常范围内的患者327例(74.66%)。(2)疾病情况:双侧发病的患者314例(71.69%);病程≤3个月的患者163例(37.21%); ARCO分期多属中晚期,其中ARCOⅢ期患者168例(38.36%);首次就诊在一级医院的患者187例(42.69%)。(3)使用激素情况:原发病中自身免疫性疾病的患者189例(43.15%);使用波尼松的患者162例(36.97%);使用激素时间≥2年以上的患者112例(25.57%);药物用法中口服患者171例(39.04%);每日使用激素含量10～20 mg以内的患者127例(29.0%);每日使用激素两次的患者128例(29.23%)。结论激素性股骨头坏死发病特征主要为:41～60岁的有原发病史的女性重体力劳动者,初中及以下文化程度为主,62.10%的患者专科医院就诊时已为ARCOⅢ、Ⅳ期,使用激素史≥1年占54.34%,每日使用激素含量多为10～20 mg、次数多为每日两次。