Surgical Treatment of Osteonecrosis of the Femoral Head Using Minimally Invasive Surgical Drilling and Cancellous Grafting at Brazzaville University Hospital  

作　　者：Kevin Parfait Bienvenu Bouhelo-Pam Marius Monka Arnauld Sledje Wilfrid Bilongo Bouyou Regis Perry Massouama Paul Yèlai Ikounga Roger Bertrand Sah Mbou Armand Moyikoua Kevin Parfait Bienvenu Bouhelo-Pam;Marius Monka;Arnauld Sledje Wilfrid Bilongo Bouyou;Regis Perry Massouama;Paul Yèlai Ikounga;Roger Bertrand Sah Mbou;Armand Moyikoua(Department of Orthopaedic surgery and Traumatology, University Hospital of Brazzaville, Brazzaville, Republic of the Congo;Faculty of Health Sciences, Marien N’GOUABI University, Brazzaville, Republic of the Congo)

机构地区：[1]Department of Orthopaedic surgery and Traumatology, University Hospital of Brazzaville, Brazzaville, Republic of the Congo [2]Faculty of Health Sciences, Marien N’GOUABI University, Brazzaville, Republic of the Congo

出　　处：《Open Journal of Orthopedics》2024年第2期122-132,共11页矫形学期刊（英文）

摘　　要：Introduction: Osteonecrosis of the femoral head (ONTF) is a debilitating condition. Several treatments have been proposed with controversial results. The aim of our study was to evaluate treatment by surgical drilling coupled with in situ cancellous grafting. Materials and methods: Our study was a case-control study conducted at Brazzaville University Hospital from 1st January 2018 to 31 December 2023. It compared two groups of patients with ONTF: non-operated (13 patients, 20 hips) and operated (22 patients, 35 hips). We used the visual digital scale (VDS) for pain assessment, the Merle D’Aubigne-Postel (MDP) scoring system for clinical and functional assessment, and the evolution of necrosis. Results: The group of non-operated patients had a mean age of 35.69 ± 3.4 years, no improvement in pain with an EVN above seven at the last recoil and a mean global MDP score falling from 12.7 before offloading to 10.13 at one year. The group of patients operated on had a mean age of 37.86 ± 7.02 years, a significant reduction in pain (p = 0.00004) and a significantly increased MDP score (p = 0.0034). A comparison of the two groups of patients showed significant stabilization of the necrotic lesions in the operated patients (p = 0.00067), with better satisfaction in the same group. Conclusion: Surgical drilling combined with grafting in the treatment of early-stage ONTF has improved progress in our series. The technique is reproducible and less invasive. It has made it possible to delay unfavorable progression and, consequently, hip replacement surgery.Introduction: Osteonecrosis of the femoral head (ONTF) is a debilitating condition. Several treatments have been proposed with controversial results. The aim of our study was to evaluate treatment by surgical drilling coupled with in situ cancellous grafting. Materials and methods: Our study was a case-control study conducted at Brazzaville University Hospital from 1st January 2018 to 31 December 2023. It compared two groups of patients with ONTF: non-operated (13 patients, 20 hips) and operated (22 patients, 35 hips). We used the visual digital scale (VDS) for pain assessment, the Merle D’Aubigne-Postel (MDP) scoring system for clinical and functional assessment, and the evolution of necrosis. Results: The group of non-operated patients had a mean age of 35.69 ± 3.4 years, no improvement in pain with an EVN above seven at the last recoil and a mean global MDP score falling from 12.7 before offloading to 10.13 at one year. The group of patients operated on had a mean age of 37.86 ± 7.02 years, a significant reduction in pain (p = 0.00004) and a significantly increased MDP score (p = 0.0034). A comparison of the two groups of patients showed significant stabilization of the necrotic lesions in the operated patients (p = 0.00067), with better satisfaction in the same group. Conclusion: Surgical drilling combined with grafting in the treatment of early-stage ONTF has improved progress in our series. The technique is reproducible and less invasive. It has made it possible to delay unfavorable progression and, consequently, hip replacement surgery.

关 键 词：HIP Osteonecrosis of the Femoral Head Conservative Treatment Surgical Drilling Bone Grafting 

分 类 号：R73[医药卫生—肿瘤]