Proszę o opinie i ewentualnie trochę informacji na temat mojego schorzenia. Mam martwicę głowki kości udowej - lewej. Doktor ze szpitala wojskowego we Wrocławiu stwierdził, że w moim przypadku będzie jeszcze wykonana dekompresja głowki kosci udowej, co zrozumiałem jakieś wiercenie i usuwanie martwych tkanek z kości. Czy ktoś miał podobny przypadek i jakie są po nim efekty.»
Status: Przed
Doczy: 12 Maj 2012 Posty: 1 Skd: Wieruszów
Wysany: Nie 13 Maj, 2012
Witam
Może ktoś wypowie sie szerzej o dekompresji. Sam juz nie wiem czy czekac na endo czy poddac sie zabiegowi odbarczania. Zdania lekarzy z którymi sie kontaktowalem są podzielone.
slatas, w każdym temacie zdania są podzielone, ale czyż nie warto ratować swojego naturalnego biodra gdy jest taka możliwość? Choćby na rok, ale to zawsze rok na własnym biodrze.
Każda technika "naprawy" biodra niesie za sobą pewien odsetek komplikacji i tutaj wybór należy do nas
Zdania lekarzy z którymi sie kontaktowalem są podzielone.
To może warto skonsultować się z najlepszym lekarzem polecanym na naszym forum? Zgadzam się z pasiflorą własny staw to zawsze własny, a z endoprotezą jeszcze zdążysz
Status: Endo x 2
Doczya: 03 Gru 2009 Posty: 2626 Skd: z Polski
Wysany: Nie 13 Maj, 2012
slatas napisa/a:
Witam
Może ktoś wypowie sie szerzej o dekompresji. Sam juz nie wiem czy czekac na endo czy poddac sie zabiegowi odbarczania. Zdania lekarzy z którymi sie kontaktowalem są podzielone.
Zdania lekarzy są również podzielone co do endoprotez i kapoplastyki.
Znam przypadki osób, które przeszły zabieg dekompresji i pomogło.
Warto próbować. Na endoprotezę zawsze przyjdzie czas.
Warto skonsultować się u któregoś z bardzo dobrych ortopedów aby mieć pewnośc swojego stanu, a skoro jest szansa na choć czasowe powodzenie operacji to moim zdaniem spróbować, do kolejki na inny rodzaj operacji możesz chyba dodatkowo trafić
_________________ *...Mamy możliwość wyboru jak wykorzystać swój czas...*...MOJA HISTORIA...*
może ktoś mi powiedzieć na temat w języku angielskim proszę chcę dzielić moje poglądy dyskusje wydają się interesujące ale i może zrozumieć jeden świat
ktoś mi pomóc
Actually AVN usually a joint specific condition. Hips are the most vulnerable because the head of the femur has an odd structure and an odd blood supply.
The blood supply is not rich so any problem like arthritis or micro-trauma that causes any degradation of the bone in the head can disrupt the blood flow and so the bone begins to die back. This is also because of how the head is 'out there' on the angled neck which makes the loading extreme. No other joint is like this although a similar thing can occur in the knee because that is also a weight bearing joint. The use of steroids or addiction to hard drugs or alcohol can have the effect of softening the bone which is the prelude to AVN. Post menopausal women (and men!) can also suffer this as a by product of osteoporosis.
AVN is graded according to the degree of damage of the head and surrounding structures. There are various systems of doing this
Steinberg modification of the Arlet and Ficat system
Grade 0. Seen on MRI or NM, normal plain film - asymptomatic
Grade 1. Seen on MRI or NM, normal plain film - symptomatic
Grade 2. Mixed sclerosis and lucency on plain films, no collapse
Grade 3. Cresentic collapse on plain films
Grade 4. More significant collapse of femoral head
Grade 5. Secondary OA of acetabulum
The combined necrotic angle of Kerboul
Only useful in stage 2 or less AVN to predict chance of collapse.
Add the necrotic angle of AVN on the coronal and sagittal images.
Less than 150º good prognosis - may spontaneously heal
Between 150º and 250º intermediate prognosis
Greater than 250º poor prognosis - will go on to collapse
Core decompression is a procedure whereby new bone or implants are implanted along the neck of the femur in an attempt to regenerate the blood supply.
Option 1.
A piece of bone, usually the fibula which lies alongside the tibia or shin bone, is taken from elsewhere in the body along with blood vessels that can be joined to the blood vessels around the upper end of the femur. It's a bit a like an organ transplant except it comes from your own body.
Problems arising from this are
a) the place where the bone is taken from is often more painful than the procedure in the hip
b) the bone graft might not survive or doesn't meld with the bone around it and the arthritic processes continue to progress.
Option 2:
There are implants that can be used instead of the bone graft. Two examples are
or two or more small rods place within the femoral neck and head
Live vascularised fibular graft is to take the mid section of the fibula in the lower leg complete with arterial attachment and a section of and insert it into the femoral head and neck - a painful procedure of its own. This is fashioned into a small bone rod complete with a pair of minor blood vessels and inserted up the neck of the femur.
The blood vessels are then attached to existing vessels in the thigh to ensure the graft has a blood supply. The objective is to bring new life to a femoral head that is suffering from avascular/aseptic (no blood) necrosis (bone death) but isn't always as successful as one would hope.
Core decompression is a procedure whereby various grafts or implants are inserted into the neck and head of the femur in an attempt to regenerate bone growth.
Live vascularised fibular graft is to take the mid section of the fibula in the lower leg complete with arterial attachment and a section of and insert it into the femoral head and neck - a painful procedure of its own. This is fashioned into a small bone rod complete with a pair of minor blood vessels and inserted up the neck of the femur.
The blood vessels are then attached to existing vessels in the thigh to ensure the graft has a blood supply. The objective is to bring new life to a femoral head that is suffering from avascular/aseptic (no blood) necrosis (bone death) but isn't always as successful as one would hope.
Some statistics from http://www.aetna.com/cpb/...0_799/0753.html
(One of several analytical studies) Steinberg et al (2001) reviewed the results of a prospective study of 406 hips in 285 patients treated by one surgeon with core decompression and bone grafting. Patients were followed-up for 2 to 14 years.
Of the 312 hips in 208 patients with a minimum 2-year follow-up, 36 % of hips (113 hips in 90 patients) required hip replacement at a mean of 29 months:
In patients treated before femoral head collapse, the outcome is significantly better than in patients who received symptomatic treatment
I had my hip replaced 5 weeks ago due to AVN. My AVN went from Stage 1 to complete collapse in less than a year. The pain you will experience if the joint collapses is a solid ten. Every AVN patient can accurately describe the exact place and time they were when the collapse occurs. I was standing in my home office after having been at my desk for about an hour. As I placed weight on the hip it collapsed. The pain send me literally to my knees.
My OS told me that all of his CD patients eventually needed a THR. He doesn't believe in doing CD's anymore , other than to relieve severe pain in patients who refuse to have a THR.
My OS told me that all of his CD patients eventually needed a THR. He doesn't believe in doing CD's anymore , other than to relieve severe pain in patients who refuse to have a THR.
I would strongly advise anyone considering a CD of the hip to spend a lot of time researching this procedure. My research confirmed my assumptions that this procedure is palliative at best.
At 5 weeks post -op I have zero pain at rest, and no joint pain with weight bearing. I doubt you'll find any CD patients who will be able to claim the same at 5 weeks post-op..
_________________ Żyj tak by jak najwięcej dać z siebie innym
Osteonecrosis is a disease which ultimately results in the destruction of the joint if left untreated. It can affect any joint but occurs most frequently in the hip. There is no agreement as to what causes osteonecrosis, although a number of factors which contribute to the disease have been identified. Different treatment options are available depending on how far along the disease has progressed. Advanced stages require a total hip replacement. However, if the disease is detected early enough, other alternatives are available. One of these alternatives is a procedure called a core decompression. This procedure involves drilling a small hole in the diseased bone. It was developed by Arlet and Ficat in 1964. David Hungerford, M.D. introduced it to the United States in 1974. All of the orthopaedic surgeons at our center are trained and experienced in the core decompression procedure.
Why a core decompression?
We have shown, as published in numerous medical journals, that there is an increase in the pressure within the diseased bone. This increase in pressure is associated with pain which in some patients becomes intolerable. Core decompression Adecompresses@ the bone. That is, it relieves the pressure from within this rigid structure. The drill hole then fills with tissue and, in some cases, new bone forms within this area. It may increase the blood flow to the diseased area of bone and allow new blood vessels to form. The procedure appears to slow down the disease process in most cases and may even stop its progression in others.
Under the right circumstances, the results of core decompression indicate that it is an effective treatment for osteonecrosis. What are the right circumstances? First, the results are best for treatment of the early stages of the disease. Results after the joint has collapsed are less successful, although in some cases pain relief still occurs. Therefore, it is best used when a hip or other joint is painful but the x-rays are normal. Second, the procedure should be performed by a surgeon experienced with the procedure. Some surgeons have reported a higher rate of complications than we have experienced.
One of the features of a core decompression is that it does not limit further surgical treatment should the disease progress. It is a relatively simple procedure and recovery from it is fairly quick. Pain relief occurs rapidly.
What should you expect?
Pre-admission testing. Within two weeks prior to your surgery, you will be asked to undergo several laboratory tests and possibly an electrocardiogram and chest x-ray. This is called pre-admission testing. This will help us to tell whether there are any conditions which might increase the risk of surgery. A physical examination, performed by your own medical doctor or hospital staff here, is also a part of pre-admission testing.
Just Before Surgery. You will not be allowed to drink or eat anything after midnight and on the morning of the surgery. In some cases, you may be allowed to take a medication you normally take in the morning with a minimal amount of water. If instructed to do so, you will need to let the admitting nurse know that you have done this.
When you come into the hospital on the day of surgery, you may have some additional x-rays that might not have been taken previously and have a physical examination by your surgeon or resident. If you have not already done so, you will be asked to sign an operative consent form to state that you understand what is being proposed and that you are in agreement that we may proceed with the operation. Just prior to surgery, an intravenous line will be started and you will be taken into the operating suite.
Anesthesia. You will be seen by an anesthesiologist on the morning of surgery. The anesthesiologist can answer specific questions you might have. Most of our surgeries are performed under spinal anesthesia. This is a very safe form of anesthesia. It is safer than general anesthesia, which is one of the reasons why we recommend it. Spinal anesthesia disturbs the major body functions a lot less than general anesthesia. Unless there are some specific reasons why a spinal anesthetic should not be used in your case, this is our preferred method of anesthesia.
The anesthesiologist will give you some medication to make you sleepy so that you're not really aware of what=s going on in the operating room. You will not be totally asleep either. However, the area that will be operated on will be totally numb throughout the operation and for several hours after the surgery.
Surgery. As stated before, the surgery involves drilling into the diseased joint. This is done with a specialized instrument that creates a Acore@ of bone that can be removed. Therefore, a core track is left in the bone which first fills up with a blood clot but eventually fills up with tissue. The surgeon uses a specialized x-ray technique, called fluoroscopy, to help him locate the precise site that he would like to drill in to. Bone graft is sometimes used to fill the hole in the bone. The surgery usually takes about 2 hours.
Recovery Room. When your surgery is completed, you will go to the recovery room where you will be closely monitored until the effects of the anesthesia and intra-operative medicines are decreased and you are relatively awake and comfortable.
Orthopaedic Unit. When you have completed your stay in the recovery room, you will be transferred to your hospital room in the orthopaedic nursing unit. If only one site is undergoing a core decompression, you may not be admitted overnight and your length of stay usually is up to 23 hours. However, if you have more than one site done, you will likely be admitted overnight. You will be instructed in how to care for your wound site and what activities you should expect to be able to perform. If you have had a core decompression of the hip, you will be taught how to use crutches.
Risks. It is important that you understand that there are risks associated with any major surgical procedure and core decompression is no exception. This section is not meant to alarm you but you really do need to know these kinds of things in order to make the decision as to whether you wish to proceed with a core decompression. These risks include the risk of death. That's true of any major surgical procedure requiring anesthesia and blood transfusion. The risk of death in our hospital for core decompression is in the order of 1 per 1,000 cases so that you can see that the risk is very small, but it's not zero. The specific risk for you will depend upon your general medical condition, your age, and the difficulty of the surgical procedure, but the risk of death itself is really very small.
Although precautions are taken, there are other potential risks that need to be taken into account. These include fracture and infection. Although these do not occur frequently, you should be aware that they could occur.
As with any surgical procedure, there is a potential risk of infection. So far, probably because core decompression is such a small procedure, we have never had an infection. You will be receiving an antibiotic on the morning of surgery and this will be continued for 24-36 hours after surgery. In spite of the antibiotics and other preventive measures taken, it is possible that an infection could develop. This could generally be treated with antibiotics and cured.
Another risk of core decompression is a fracture. The drill hole creates a Astress riser or weak point in the bone. The incidence of fracture at our hospital is about 1 in 200 cases. It is important to minimize the weight and activity placed on this area during the healing process. With hips, this area is particularly at risk if you should fall. Therefore, it is important that you use crutches or a walker for 6 weeks.
Activity.
Your activity level will depend on which joint or joints have undergone a core decompression. As we have stated previously, with core decompression of the hip, you will be instructed to use crutches for six weeks, possibly longer depending on the severity of the disease. This is to protect against fracture through the A drill hole in the bone. After this, you should be able to return to the normal activity of daily living. Your ultimate maximum advisable activity depends on many factors and should be discussed with your surgeon.
_________________ Żyj tak by jak najwięcej dać z siebie innym
Pomogłaś, dzięki. Jeśli jest szansa że dekompresja pomoże komuś w rewaskularyzacji przy martwicy to chyba warto spróbować. Sam się nad tym zastanawiam, bo lekarz nakłania (początkowe stadium martwicy po wypadku w marcu tego roku)
Witam. Poszukuję osób u których wykonano nawiercanie kości udowej i wypełniono preparatem kościozastępczym. Jestem właśnie po takim zabiegu, ale nie mogę znaleźć informacji nt. skuteczności tego zabiegu. Lekarz powiedział, że skuteczność wynosi 60% szans, nie wiem czy to dużo, czy mało.
