Clinical and Biomechanical Study to Develop a Joint-Preserving Therapy for Femoral Head Osteonecrosis

开发股骨头坏死保关节疗法的临床和生物力学研究

• 批准号: 240624258
• 负责人: Professor Dr.-Ing. Wojciech Grzegorz Kowalczyk
• 金额: --
• 依托单位: Lehrstuhl für Mechanik und Robotik
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2013
• 资助国家: 德国
• 起止时间: 2012-12-31 至 2017-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/240624258?language=en
• 关键词: Clinical; Biomechanical; Study; Develop; Joint

Aseptic osteonecrosis of the femoral head is a serious disease which results in destruction of the hip if left untreated. A new surgical procedure which preserves the femoral head has been developed for patients with a still intact femoral head at the time of diagnosis. The aim of this procedure is to completely remove all necrotic tissue through an exactly targeted drill channel using a special instrument. The femoral head is then stabilised with a bone substitute based on calcium phosphate and calcium sulphate. Postoperatively, the bone substitute material is resorbed and replaced by newly formed cancellous bone. So far, clinical follow-up of this therapy has revealed better results than the conventional core decompression therapy without removal of the necrotic tissue and other femoral head preserving procedures. The results also showed that the success of the therapy depends significantly on the size of the necrotic area and the amount of necrotic tissue remaining in the void. Histological investigations of collapsed femoral heads after advanced core decompression also confirm the necessity of complete removal of all necrotic tissue, as bone regeneration was seen only at the interface between healthy cancellous bone and the bone substitute material. However, MRI follow-up examinations show that it is often not possible to completely remove all necrotic tissue because even the smallest deviation from the optimal drill channel position leads to markedly inferior resection and current instruments do not enable complete removal in all cases. The aim of this study is to optimise the drilling procedure and removal of necrotic tissue. To achieve this, a better understanding of the biomechanical properties of the femoral head, especially with regard to its postoperative stability, is necessary. Therefore, various entry points and angles of the drilling channel and subsequent filling with two different types of bone substitute material will be investigated, both experimentally and numerically. Based on the results, a special planning programme will be developed and combined with a navigation system which will enable optimal removal of the necrotic tissue taking biomechanical conditions into consideration. A further aim of the study is to optimise the drilling instruments. All modifications will be re-evaluated in the light of findings obtained from follow-up examinations of the patients treated.

股骨头无菌性骨坏死是一种严重的疾病，如果不及时治疗，会导致髋关节的破坏。一种新的保留股骨头的外科手术已经被开发出来，用于在诊断时股骨头仍然完整的患者。该手术的目的是使用一种特殊的器械，通过一个精确定位的钻孔通道完全去除所有坏死组织。然后用基于磷酸钙和硫酸钙的骨替代物稳定股骨头。术后，骨替代物被吸收并被新形成的松质骨取代。到目前为止，该疗法的临床随访显示比传统的不切除坏死组织和其他股骨头保留手术的核心减压疗法效果更好。结果还表明，治疗的成功在很大程度上取决于坏死区域的大小和空洞中残留的坏死组织的数量。深度股骨头减压后股骨头塌陷的组织学检查也证实了完全去除所有坏死组织的必要性，因为骨再生仅在健康松质骨和骨替代材料之间的界面上可见。然而，MRI随访检查显示，通常不可能完全切除所有坏死组织，因为即使最小的偏离最佳钻孔通道位置也会导致明显的切除不足，而且目前的器械并不能完全切除所有病例。本研究的目的是优化钻孔程序和去除坏死组织。为了实现这一目标，有必要更好地了解股骨头的生物力学特性，特别是其术后稳定性。因此，我们将通过实验和数值两种方法来研究钻孔通道的不同入口点和角度，以及随后用两种不同类型的骨替代材料进行填充。根据结果，将制定一个特殊的规划方案，并结合导航系统，在考虑生物力学条件的情况下，以最佳方式去除坏死组织。研究的另一个目标是优化钻井仪器。所有修改将根据治疗患者的随访检查结果重新评估。