鑽洞減壓術治術早期非創傷性股骨頭缺血性壞死

Multiple K－wire Drilling in the Treatment of Early－stage Avascular Necrosis of the Feoral Head

早期的股骨頭缺血性壞死如果不加以治療，絕大部份都會繼續惡化，最終需以全人工關節置換來治療。對於早期骨頭缺血性壞死的治療，以3mm K-wire做骨頭鑽洞術取代傳統以環型鑽孔器（Trephine）做核心減壓術。本研究包括17位患者共20例早期壞死的股骨頭。術前評估包括臨床症狀、一般X光攝影及核磁共振掃瞄。術中評估包括股頭鑽洞前後的骨內壓力。，術後追蹤從一年至三年又五個月，平均為一年又八個月。術中的骨內壓力測定，可以發現行股骨頭鑽洞術後，骨內壓力由平均 66.2 mmHg 降至24.4 mmHg。術後病人疼痛情況皆有明顯的改善。在追蹤期間有8例在X光檢查時發現病症加劇，其中6例需進行全人工髖關節換置手術。綜觀本研究的結果，以 3 mm K-wire做股骨頭鑽洞術，可以有效降低股骨頭內壓力，減低髖關節疼痛。病人所受的局部組織傷害小，而且沒有併發症。長期來講，其結果與傳統的環型鑽孔器核心減壓術的結果相當。

In most patients, the avascular necrosis of the femoral head progresses to collapse and eventual degenerative arthritis, Several methods have been adopted for the treatment of early-stage avascular necrosis of the femoral head, to avoid total hip arthroplasty. One such method is core decompression. We have treated 20 femoral heads(17 patients)with early-stage avascular necrosis by core decompression. Core decompression was accomplished by multiple drilling with 3 mm K-wire. The intraosseous pressure of the femoral head was recorded before and after drilling. The intraosseous pressure decreased immediately in all cases (66.2 ± 21.9 mmHg to 24.4 ± 11.6mmHg), and relief of resting hip pain was noted on the first postoperative day. The average postoperative follow-up period. In eight cases the radiologic stage worsened, and total hip arthroplasty was required in six. Core decompression by multiple K-wire drilling is and uncomplicated procedure, which requires only simple instruments. It is helpful in the treatment of early-stage avascular necrosis of the femoral head. The intraosseus pressure decreased immediately, with marked pain relief. The clinical success rate of this procedure was 60%, which is compatible with the results of reported core decompression treatments.