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1、DoModernTechniquesImproveCoreDecompressionOutcomesforHipOsteonecrosis?2011-09-13ContentIntroductionJournal:ClinOrthopRelatResIF:2.116Publishedyear:2008Author:FromSinaiHospitalofBaltimoreUSASystematicReviewAbstractObject:todeterminewhethertheefficacyimprovedduringthelast15yearsM
2、ethod:1.comparedthesuccessratesbefore1992VS1992-20072.evaluatedtheoutcomesofour52patients(79hips)treatedwithmultiplesmall-diameterdrillings.Result:1.decreaseinadditionalsurgeriesandincreaseinradiographicsuccess2.smalllesionsandFicatStageIhadthebestresultswith79%noradiographicpr
3、ogressionConclusion:coredecompressionisasafeandeffectiveprocedureQuestions1.whethertheefficacyofcoredecompressionhasimprovedduringthelast15years?2.whethermoderntechniquesprovidebetteroutcomesthanthosenon-operativetreatment?3.whethertheoutcomestreatedusingsmall-diameterdrillingw
4、eresimilartoothermodernstudies?4.whetherpatientslessradiographicprogressionandsmallerlesionsizesusingsmalldiameterdrillingwouldbelesslikelytohavepooroutcomes?Inclusioncriteria1.providedradiographicoutcomesand/orindicatedwhetherpatientsunderwentadditionalsurgeries2.Onlythemostre
5、centstudieswereincludedatmultipletimesatdifferentfollowups3.theuseofancillarycancellousbonegrafting4.previouslyunpublishedresultsatourinstitutiontreatedusingasmall-diameterdrillingExclusioncriteria1.notprovidesufficientdatatoanalyzeoutcomes2.fewerthan10patients3.Patientsyounger
6、than18yearsold4.usedlongcorticalstrutbonegraftingorvascularizedbonegrafting5.ameanfollowupoflessthan18monthsCriteriaforassessingeffectivenessMeasureInclusion/ExclusioncriteriaExamplesAdditionalsurgery1.IncludeadditionalsurgeriesTHA,vascularizedboneassociatedwithprogressiongraft
7、ing,osteotomyofosteonecrosis.2.ExcludesurgeriesnotdirectlyEvacuationofahematomarelatedtolong-termfailureofcoredecompression.Radiographicfailure1.Includeprogressiontocollapse.Progressionfrom2.IncludeprogressionFicatIItoIII.fromcollapsetofurtherSteinbergIVtoV.stageofdegeneration3
8、.ExcludeprogressionProgressionfromwithoutcollapse.ARCO
