BACKGROUND Osteonecrosis of the femoral head(ONFH)is a destructive condition most commonly affecting young and middle-aged patients.The leading consequence of ONFH is often a significant articular disability.Effective...BACKGROUND Osteonecrosis of the femoral head(ONFH)is a destructive condition most commonly affecting young and middle-aged patients.The leading consequence of ONFH is often a significant articular disability.Effective joint-preserving surgical treatments are urgently needed for patients with early stage ONFH when outcomes of treatment are in general better than the advanced stage disease.AIM To introduce a new surgery procedure called percutaneous expanded core decompression and mixed bone graft technique,which is a new way of jointpreserving surgical treatments.METHODS The clinical data of 6 patients with ONFH diagnosed and treated with the procedure called percutaneous expanded core decompression and mixed bone graft technique at The First Hospital of Qiqihar from March 2013 to August 2019 were retrospectively analyzed;the follow-up ended in December 2019.RESULTS There were 6 male patients with an average age of 43 years in our study.Gratifying results have been obtained from the comparison of Harris hip score,visual analogue scale,and imaging examination before and after operation.CONCLUSION This new modified technique is simple,safe,and reliable.No serious perioperative complications were observed in our cases.Advantages of the single blade expandable reamer are obvious.The adjuvant substance is inexpensive and easy to obtain.Thus,this technique is an effective joint-preserving surgical treatment for patients with early stage of ONFH.展开更多
Objective: to analyze and compare the therapeutic effect of osteonecrosis of femoral head in early and middle stage patients with conservative core decompression and bone grafting through clinical examples. Methods: f...Objective: to analyze and compare the therapeutic effect of osteonecrosis of femoral head in early and middle stage patients with conservative core decompression and bone grafting through clinical examples. Methods: from October 2019 to November 2020, 88 patients diagnosed and treated in our hospital in the early and middle stage of femoral head necrosis were randomly selected. According to the way of current clinical treatment and research objects, they are divided into theoretical research group and control group. There were 44 cases in each group. The control group mainly used conservative treatment, and the study group mainly used core decompression and bone grafting. Visual analogue scale (vas) and hip joint score (harris) were compared in both groups. Results: there was no significant difference in visual analogue and total hip score between the two groups before treatment (P > 0.05). Visual analogue scores and hip scores improved between the two clinical patient groups after treatment. The vas and harris scores of the study group were significantly lower than those of the normal control group, and the harris scores had a significantly higher effect than those of the healthy control group (P < 0.05). Conclusions: patients with early and middle stage femoral head necrosis can achieve special clinical effects through a variety of treatment methods, but the core decompression bone grafting operation of a variety of treatment approaches and methods of clinical effect is more obvious, promote the rehabilitation of the hip function of patients and improve the quality of life and level of patients.展开更多
Sickle cell disease(SCD)is a genetic disorder characterized by chronic hemolysis and vaso-occlusive crises(VOCs),leading to musculoskeletal complications that significantly affect quality of life.Among these,shoulder ...Sickle cell disease(SCD)is a genetic disorder characterized by chronic hemolysis and vaso-occlusive crises(VOCs),leading to musculoskeletal complications that significantly affect quality of life.Among these,shoulder complications are a concern,with humeral head avascular necrosis(AVN)being the second most common site of involvement after the femoral head.Other shoulder pathologies,including osteomyelitis and septic arthritis,further contribute to morbidity.However,these conditions remain underdiagnosed and understudied,often due to overlapping symptoms with VOC-related bone infarctions.Imaging,particularly magnetic resonance imaging,is crucial for early diagnosis and accurate differentiation.Management strategies range from conservative pain control to surgical interventions,including core decompression for early-stage AVN and arthroplasty for advanced joint destruction.Surgical outcomes in SCD,however,remain inconsistent due to higher complication rates and a lack of standardized guidelines.Despite advancements in diagnosis and treatment,shoulder pathology in SCD remains an area of limited research.This review highlights the need for larger,long-term studies with a homogeneous etiology to support and refine current treatment strategies and improve patient outcomes.展开更多
Background:Avascular necrosis of femoral head(AVNFH)typically presents in the young adults and progresses quickly without proper treatments.However,the optimum treatments for early stage of AVNFH are still controversi...Background:Avascular necrosis of femoral head(AVNFH)typically presents in the young adults and progresses quickly without proper treatments.However,the optimum treatments for early stage of AVNFH are still controversial.This study was conducted to evaluate the therapeutic effects of multiple small-diameter drilling decompression combined with hip arthroscopy for early AVNFH compared to drilling alone.Methods:This is a nonrandomized retrospective case series study.Between April 2006 and November 2010,60 patients(98 hips)with early stage AVNFH participated in this study.The patients underwent multiple small-diameter drilling decompression combined with hip arthroscopy in 26 cases/43 hips(Group A)or drilling decompression alone in 34 cases/55 hips(Group B).Patients were followed up at 6,12,and 24 weeks,and every 6 months thereafter.Radiographs were taken at every follow-up,Harris scores were recorded at the last follow-up,the paired t-test was used to compare the postoperative Harris scores.Surgery effective rate of the two groups was compared using the Chi-square test.Results:All patients were followed up for an average of 57.6 months(range:17-108 months).Pain relief and improvement of hip function were assessed in all patients at 6 months after the surgery.At the last follow-up,Group A had better outcome with mean Harris'scores improved from 68.23±11.37 to 82.07±2.92(t=-7.21,P=0.001)than Group B with mean Harris'scores improved from 69.46±9.71 to 75.79±4.13(t=-9.47,P=0.037)(significantly different:t=-2.54,P=0.017).The total surgery effective rate was also significantly different between Groups A and B(86.0%vs.74.5%;Z2=3.69,P=0.02).Conclusion:For early stage of AVNFH,multiple small-diameter drilling decompression combined with hip arthroscopy is more effective than drilling decompression alone.展开更多
基金Supported by The First Hospital of Qiqihar,No.2013-006Department of Veterans Affairs and the Veterans Administration Medical Center in Memphis,No.I01 BX000671.
文摘BACKGROUND Osteonecrosis of the femoral head(ONFH)is a destructive condition most commonly affecting young and middle-aged patients.The leading consequence of ONFH is often a significant articular disability.Effective joint-preserving surgical treatments are urgently needed for patients with early stage ONFH when outcomes of treatment are in general better than the advanced stage disease.AIM To introduce a new surgery procedure called percutaneous expanded core decompression and mixed bone graft technique,which is a new way of jointpreserving surgical treatments.METHODS The clinical data of 6 patients with ONFH diagnosed and treated with the procedure called percutaneous expanded core decompression and mixed bone graft technique at The First Hospital of Qiqihar from March 2013 to August 2019 were retrospectively analyzed;the follow-up ended in December 2019.RESULTS There were 6 male patients with an average age of 43 years in our study.Gratifying results have been obtained from the comparison of Harris hip score,visual analogue scale,and imaging examination before and after operation.CONCLUSION This new modified technique is simple,safe,and reliable.No serious perioperative complications were observed in our cases.Advantages of the single blade expandable reamer are obvious.The adjuvant substance is inexpensive and easy to obtain.Thus,this technique is an effective joint-preserving surgical treatment for patients with early stage of ONFH.
文摘Objective: to analyze and compare the therapeutic effect of osteonecrosis of femoral head in early and middle stage patients with conservative core decompression and bone grafting through clinical examples. Methods: from October 2019 to November 2020, 88 patients diagnosed and treated in our hospital in the early and middle stage of femoral head necrosis were randomly selected. According to the way of current clinical treatment and research objects, they are divided into theoretical research group and control group. There were 44 cases in each group. The control group mainly used conservative treatment, and the study group mainly used core decompression and bone grafting. Visual analogue scale (vas) and hip joint score (harris) were compared in both groups. Results: there was no significant difference in visual analogue and total hip score between the two groups before treatment (P > 0.05). Visual analogue scores and hip scores improved between the two clinical patient groups after treatment. The vas and harris scores of the study group were significantly lower than those of the normal control group, and the harris scores had a significantly higher effect than those of the healthy control group (P < 0.05). Conclusions: patients with early and middle stage femoral head necrosis can achieve special clinical effects through a variety of treatment methods, but the core decompression bone grafting operation of a variety of treatment approaches and methods of clinical effect is more obvious, promote the rehabilitation of the hip function of patients and improve the quality of life and level of patients.
文摘Sickle cell disease(SCD)is a genetic disorder characterized by chronic hemolysis and vaso-occlusive crises(VOCs),leading to musculoskeletal complications that significantly affect quality of life.Among these,shoulder complications are a concern,with humeral head avascular necrosis(AVN)being the second most common site of involvement after the femoral head.Other shoulder pathologies,including osteomyelitis and septic arthritis,further contribute to morbidity.However,these conditions remain underdiagnosed and understudied,often due to overlapping symptoms with VOC-related bone infarctions.Imaging,particularly magnetic resonance imaging,is crucial for early diagnosis and accurate differentiation.Management strategies range from conservative pain control to surgical interventions,including core decompression for early-stage AVN and arthroplasty for advanced joint destruction.Surgical outcomes in SCD,however,remain inconsistent due to higher complication rates and a lack of standardized guidelines.Despite advancements in diagnosis and treatment,shoulder pathology in SCD remains an area of limited research.This review highlights the need for larger,long-term studies with a homogeneous etiology to support and refine current treatment strategies and improve patient outcomes.
文摘Background:Avascular necrosis of femoral head(AVNFH)typically presents in the young adults and progresses quickly without proper treatments.However,the optimum treatments for early stage of AVNFH are still controversial.This study was conducted to evaluate the therapeutic effects of multiple small-diameter drilling decompression combined with hip arthroscopy for early AVNFH compared to drilling alone.Methods:This is a nonrandomized retrospective case series study.Between April 2006 and November 2010,60 patients(98 hips)with early stage AVNFH participated in this study.The patients underwent multiple small-diameter drilling decompression combined with hip arthroscopy in 26 cases/43 hips(Group A)or drilling decompression alone in 34 cases/55 hips(Group B).Patients were followed up at 6,12,and 24 weeks,and every 6 months thereafter.Radiographs were taken at every follow-up,Harris scores were recorded at the last follow-up,the paired t-test was used to compare the postoperative Harris scores.Surgery effective rate of the two groups was compared using the Chi-square test.Results:All patients were followed up for an average of 57.6 months(range:17-108 months).Pain relief and improvement of hip function were assessed in all patients at 6 months after the surgery.At the last follow-up,Group A had better outcome with mean Harris'scores improved from 68.23±11.37 to 82.07±2.92(t=-7.21,P=0.001)than Group B with mean Harris'scores improved from 69.46±9.71 to 75.79±4.13(t=-9.47,P=0.037)(significantly different:t=-2.54,P=0.017).The total surgery effective rate was also significantly different between Groups A and B(86.0%vs.74.5%;Z2=3.69,P=0.02).Conclusion:For early stage of AVNFH,multiple small-diameter drilling decompression combined with hip arthroscopy is more effective than drilling decompression alone.
