The Experts below are selected from a list of 126 Experts worldwide ranked by ideXlab platform
V Klingmuller - One of the best experts on this subject based on the ideXlab platform.
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preliminary results of treatment with vascular pedicled iliac bone chip in Femur Head Necrosis
Zeitschrift Fur Orthopadie Und Ihre Grenzgebiete, 2008Co-Authors: G Schwetlick, U Weber, J Hofmann, V KlingmullerAbstract:For revascularisation of femoral Head with osteoNecrosis and pseudarthrosis of the femoral neck 68 femoral Head were treated with a pedicled bonegraft. Therefore were taken the medial bonegraft (A. circumflexa ilium profunda) and the lateral bonegraft, based on the deep branches of the superior gluteal vessels. On the basis of postexamination it is reported about the first 35 patients, who were treated with a medial autological pedicled bonegraft. Prae- and postoperative each of them was clinical, radiological and angiological examinated. Because of this operation in 78.8% the clinical picture, existing about pain and the ability to walk and move, could be improved.
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vascular pedicled iliac bone graft in therapy of Femur Head Necrosis in the adult clinical and angiographic results
Zeitschrift Fur Orthopadie Und Ihre Grenzgebiete, 2008Co-Authors: G Schwetlick, H Rettig, V KlingmullerAbstract:23 hip joints with hip Head Necrosis in 22 patients were provided with a pedicle bone-graft perfused by the art. circumflexa ilium profunda. I two cases it was necessary to remove the bone-graft contralaterally because bone had already been removed from the side with the Necrosis at an earlier date. In these cases the arterio-venous bundle of vessels of the autologous heterotope transplant was connected through microanastomosis with the arteria and vena circumflexa femoris lateralis. In addition to the usual clinical follow-up the method of superselective angiography was also applied to make possible direct perfusion control of the implanted bone-graft in the operated patients. In 18 of the 23 pedicle autologous heterotope transplants unimpeded perfusion could be shown. By introducing regional stress angiography in 7 cases it became possible to make further well-founded statements about the physiotherapeutical follow-up treatment. Electronic subtraction provides a more accurate assessment of even the minutest arteries possible.
Wenlong Yang - One of the best experts on this subject based on the ideXlab platform.
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clinical acupuncture therapy for Femur Head Necrosis a protocol for systematic review and meta analysis
Medicine, 2021Co-Authors: Hongyu Wang, Fengyun Yang, Zhiwen Cao, Yunfeng Luo, Jiangyuan Liu, Zhijun Yang, Hanting Xia, Zhaochong Mao, Wenlong YangAbstract:Background Femur Head Necrosis (FHN) is a common clinical joint orthopedic-related disease, and its incidence is increasing year by year. Symptoms include dull pain and dull pain in the affected hip joint or its surrounding joints. More severely, it can lead to limited joint movement and inability to walk autonomously. Surgical treatment has many sequelae. The high cost makes it unaffordable for patients, and the side effects of drug treatment are unknown. A large number of clinical studies have shown that acupuncture is effective in treating femoral Head Necrosis. Therefore, this systematic review aims to explore the safety and effectiveness of acupuncture in the treatment of femoral Head Necrosis. Methods We will conduct a comprehensive literature search in Medline, PubMed, Cochrane Database of Systematic Reviews, Embase, Chinese Biomedical Literatures Database (CBM), China National Knowledge Infrastructure (CNKI), Wang FangDatabase (WF), Chinese Scientific Journal Database (VIP) from inception to May 2021 without any language restriction. In addition, we will retrieve the unpublished studies and the references of initially included literature manually. The two reviewers will identify studies, extract data, and assess the quality independently. The outcomes of interest include: total effective rate; the total nasal symptom score; Hip function (Hip Harris joint score, WOMAC hip score, hip joint Lequesne index score, Merle D 'Aubigne and hip joint Postel score); Adverse events. Randomized clinical trials will be collected, methodological quality will be evaluated using the Cochrane risk-of-bias assessment tool, and the level of evidence will be rated using the Grading of Recommendations, Assessment, Development and Evaluation approach. Meta-analysis will be performed using RevMan 5.4.0 software. The heterogeneity test will be conducted between the studies, P 50% are the thresholds for the tests. We will utilize the fixed effects model or the random effects model according to the size of heterogeneity. Results The meta-analysis program will systematically evaluate the efficacy and safety of acupuncture in the treatment of FHN patients. Conclusion This study will investigate whether acupuncture can be used as one of the non-surgical and non-pharmacological therapies for the prevention or treatment of FHN. Trial registration number INPLASY202150035.
Peijian Tong - One of the best experts on this subject based on the ideXlab platform.
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progress on tantalum rod implanting for the treatment of Femur Head Necrosis
China Journal of Orthopaedics and Traumatology, 2013Co-Authors: Xiaokang Tang, Peijian Tong, Yanhua Fan, Hang Ying, Luwei XiaoAbstract:Incorrect treatment for Femur Head Necrosis can cause collapse of femoral Head and tresult in severe harm for the patients (especially for the patient with middle-aged and young). The structure and mechanics characteristics of tantalum rod is similar to bone tissue, it higher strength and can adapt the internal environment of organism, so it has a large potency in treating Femur Head Necrosis. Treatment of early Femur Head Necrosis with tantalum rod implanting had alreadly widey applied at home and abroad, the method has the advantages of simple operation, little risk, less complication and beseems the patient with stage I - II of ARCO. But reasons that the difficult diagnosis of early Femur Head Necrosis, localized effect of tantalum rod, different experience of medical worker,caused the contentions about effect of tantalum rod implanting. With development of science, tantalum rod implanting combined with correlative biotechnology should raise the effect in treating Femur Head Necrosis.
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research progress on proteomics in Femur Head Necrosis
China Journal of Orthopaedics and Traumatology, 2013Co-Authors: Xiaocheng Zhou, Letian Shan, Luwei Xiao, Peijian TongAbstract:Appearance of proteomics technology can fleetly filt and reveal specificity biomarkers of disease, this will help to reveal the pathogenesis of Femur Head Necrosis and help early diagnosis, find more effective methods and therapeutic targets. At present, they are hot spots that find out the occurred mechanism,related proteins of early diagnosis and early treatment and its functional identification; set up the early related database; optimize the protein extraction methods for research of Femur Head Necrosis. This article reviews the application of study technology of related proteins of Femur Head Necrosis on bone tissue, serum,related animal model,and in order to provide further research ideas.
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forecasting and prevention of collapse in Femur Head Necrosis
China Journal of Orthopaedics and Traumatology, 2010Co-Authors: Peijian Tong, Shilong Zhang, Xiang FangAbstract:By discussing different ways on prediction, prevention and treatment of Femur Head Necrosis (FHN), to provide a theory reference for future clinical application. By searching, reading and summarizing related-literatures through CNKI, VIP, CBM and foreign-related literature, to sum up the relevance methods and techniques of currently used. It was found that imaging study (especially X-ray and MRI) was of great importance in prediction. There were several ways (both non-surgical or surgical) for prevention and treatment. FHN collapse was affected by many factors, but most of the researches were all focus on one aspect of the mechanism and based on small samples. It is necessary to have a research with a large sample and to compare the effect on different treatment. Early and effective imaging inspection is needed for high risk group of FHN; possibility of collapse should be predicted for existing FHN; core decompression or vascularized bone grafting are required for collapse of high risk group. Early prediction and treatment are essential for FHN patients.
S Hofmann - One of the best experts on this subject based on the ideXlab platform.
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diagnostic imaging in Femur Head Necrosis
Orthopade, 2000Co-Authors: J Kramer, Martin Breitenseher, H Imhof, M Urban, H Plenk, S HofmannAbstract:Abstract Diagnosis of avascular Necrosis (AVN) of the hip has been improved by the technical progress of imaging modalities during the last decade. For a long period, only plain radiographs had been available. Scintigraphy and computed tomography contributed to differential diagnosis and early detection of bone Necrosis. In the meantime, MR imaging has gained special value in the evaluation of AVN. It is now the method of choice for early detection as well as for assessment in later stage disorders. Using the ARCO system, all imaging modalities and their diagnostic viability are described. Findings regarding the different stages of AVN are correlated to tissue-specific changes.
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pathomorphological aspects and repair mechanisms of Femur Head Necrosis
Orthopade, 2000Co-Authors: H Plenk, Martin Breitenseher, S Hofmann, M UrbanAbstract:The pathomorphologies of non-traumatic femoral Head osteonecroses (ON) are usually similar, despite various known pathogenetic factors. The size and position of the subchondral bone and marrow segment, becoming necrotic after the ischemic event(s), and the kind of repair processes determine the time course and thus the fate of this hip joint disease. Four cases of conservatively or core decompression-treated femoral Head ON were selected to demonstrate differently effective repair mechanisms which are discussed in respect to existing therapeutic concepts. Diagnostic criteria from magnetic resonance imaging follow-ups were correlated with light microscopy findings on undecalcified ground and microtome sections from femoral Heads retrieved at total joint replacement. Initial stage (ARCO 0) and reversible early stage ON (ARCO 1) after incomplete ischemias can apparently show spontaneous sufficient repair. After extensive and complete ischemia, however, ON progresses without detectable changes on plain radiographs into irreversible early stage ON (ARCO stage 2). Only in exceptional cases (with small, medially located necroses), a spontaneous sufficient repair seems possible. Usually, early ARCO stage 2 ON with intact articular surface shows no remodeling of the subchondral necrotic bone and fatty marrow, but only ineffective repair with fibrovascular tissue invasion and bone resorption at the vital bone border. Repeated bone appositions on partly resorbed necrotic trabeculae form the sclerotic rim in this pathognomonic reactive interface. New bone formation can also be increased underneath the necrotic area and reactive interface when surrounded by accompanying bone marrow edema. Core decompression in ARCO stage 2 ON, even if it reaches the necrotic lesion, can at best delay progression of the disease, but never leads to complete reconstruction of the necrotic area. More likely, after both conservative and operative treatment, destructive resorption without effective consecutive bone formation will lead sooner or later to collapse of the articular surface and thus to mechanical instability of transition stage ON (ARCO stage 3). On the other hand, this subchondral fracture can apparently also cause reconstructive repair which, by involving chondral and membranous ossification in this "creeping substitution", can reduce the necrotic area. However, it cannot prevent progression into late stage ON (ARCO stage 4) with secondary joint destructions. Principally, besides the rare sufficient repair in initial and certain early ON, three forms of insufficient repair in the necrotic area can be distinguished: lack of remodeling, destructive remodeling, and reconstructive remodeling. To date, no therapeutical intervention exists which leads to complete healing of irreversible ON stages by reconstructive repair. Improved understanding of pathomorphology and repair mechanisms, however, could be the basis for future therapeutical concepts which should aim at the complete regeneration of the osteonecrotic area.
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transient osteoporosis as a special reversible form of Femur Head Necrosis
Orthopade, 2000Co-Authors: S Hofmann, Martin Breitenseher, M Urban, W Schneider, H PlenkAbstract:There is still controversy whether transient osteoporosis of the hip joint represents a distinct self-limiting disease, or reflects only an early, reversible subtype of non-traumatic osteoNecrosis (ON). Transient osteoporosis has several synonyms: algodystrophy of the hip; transient marrow oedema; or bone marrow oedema syndrome--BMOES. Clinical presentation of BMOES shows mechanical hip joint pain, ON risk factors, and a diffuse bone marrow oedema in MR imaging. Histomorphological changes resemble early ON, but with diffuse sufficient repair in BMOES and focal and insufficient repair only at the border of the necrotic lesion in ON. Therefore the clinical course and outcome are significant different, with restitution occurring in BMOES, while progressive destruction of the joint takes place in ON. So far, the preferred treatment strategies are protected weight bearing for BMOES, but operative treatment for ON. In a prospective study of patients with BMOES, the clinical, radiographic, and MRI course of 43 hip joints after core decompression treatment were investigated. All patients showed immediate relief of pain after surgery and the average duration of symptoms with conservative treatment could be dramatically reduced by core decompression from 6 months down to 2 months. There were no perioperative complications. Based on our experience with over 100 BMOES patients, we are convinced that this syndrome represents not a distinct disease but an early reversible subtype of non-traumatic ON. Due to the excellent clinical results of core decompression, we recommend this operative therapeutical concept in patients with painful BMOES.
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the value of core decompression in treatment of Femur Head Necrosis
Orthopade, 2000Co-Authors: W Schneider, Martin Breitenseher, H Plenk, A Engel, K Knahr, S HofmannAbstract:Core decompression of the necrotic area for treatment of idiopathic osteoNecrosis of the femoral Head was developed and published by Ficat and Arlet in 1962 within the scope of their "Functional exploration of bone". The mode of action is attributed to a reduction of the intramedullary pressure in the bony compartment of the femoral Head. The possibilities of repair and bone regeneration following core decompression are still discussed controversially. Core decompression is a common but not generally accepted procedure in the treatment of idiopathic osteoNecrosis of the femoral Head. After first publications of positive mid- and long-term effects, some subsequent studies judged it as an ineffective and high-risk method. Analysis of the literature shows that the effectiveness of core decompression depends on the stage of osteoNecrosis at the time of surgical intervention. Prognosis is influenced by the extent and location of the necrotic area, the presence and amount of Head depression, and continued risk factors--mainly corticoid medication. The best prognosis can be given for patients with a small, medial-centrally located Necrosis without Head depression. The classification according to Ficat appears to be insufficient, as the extent and localization of the necrotic area are not assessed. Magnetic resonance imaging has become a diagnostic gold standard, as radiographic diagnosis showed poor sensitivity and specificity, especially in the early stages of the disease. As an essential part, MRI was integrated into the new classification of the "Association Internationale de Recherche sur la Circulation Osseuse" (ARCO). On account of the literature and our own experience, treatment by core decompression can be recommended in cases of reversible early stages of osteoNecrosis (ARCO 1), as well as in those cases of irreversible early stages (ARCO 2) that show a medial or central location of the Necrosis with an extent of less than 30% of the femoral Head. Once the disease reaches the irreversible early stage, complete recovery cannot be expected. In these cases only reduction of pain and retardation of the natural course of the osteoNecrosis are possible to gain time until total hip replacement is unavoidable.
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the non traumatic Femur Head Necrosis in the adult ii radiologic diagnosis and staging
Radiologe, 1994Co-Authors: J Kramer, S Hofmann, H ImhofAbstract:In recent years diagnosis, and in particular early diagnosis, of osteoNecrosis of the hip has been much improved by modern imaging modalities. Magnetic resonance imaging is widely accepted as the primary imaging modality for the early detection of this disorder and can help to facilitate the therapeutic management in later stages. However, plain radiographs, bone scans and computed tomography are still important techniques, which cannot be avoided in most cases. This paper describes the relative values of the different modalities. The staging system used is the international ARCO system.
Chongwei Chen - One of the best experts on this subject based on the ideXlab platform.
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treatment of adult early Femur Head Necrosis with the tantalum screw
China Journal of Orthopaedics and Traumatology, 2011Co-Authors: Huayun Luo, Chongwei ChenAbstract:OBJECTIVE To investigate a new method for the treatment adult early Femur Head Necrosis in order to avoid further collapse and Necrosis and improve the clinical symptoms. METHODS From January 2009 to June 2010, 10 hips of 9 patients, including 7 males and 2 females, aged from 29 to 63 years old (averaged 44.1), with Femur Head Necrosis were treated with implantation of the tantalum screw. The X-ray film, CT scan and MRI were performed before operation. According to Steinberg staging, stage I was in 1 case (1 hip), stage II a in 4 cases(5 hips), stage II b in 4 cases (4 hip). With the C-arm X-ray conducted guide, wire was drilled into the center of Femur Head Necrosis regions from the greater trochanter bottom, hollow bodkin enlarged marrow along the guide wire, scraped Necrosis sequestrum, transplanted bone if necessary,then implantated the appropriate tantalum screw to prop up the articular surface. The patients were followed up at 3rd, 6th, 9th month postoperatively, the clinical effects were evaluated according to the JOA criteria, and the changes of the femoral Head were observed by X-rays. RESULTS The mean operative time was 50 min (ranged from 40 to 60 min); the mean blood loss was 80 ml (ranged from 60 to 100 ml). There was no complications, such as postoperative infection, fracture, deep vein thrombosis and so on. All patients were followed up more than 9 months. No aggravation in collapse and Necrosis were found by regular X-ray examination. Post-operative JOA score increased month by month. JOA scores increased obviously from preoperative (31.30 +/- 19.63) to (54.10 +/- 13.20), (69.90 +/- 15.04), (87.00 +/- 8.83) at the 3,6,9 months after operation, respectively. CONCLUSION The tantalum screw implantation is simple and effective for the treatment of adult early Femur Head Necrosis, and can effectively avoid collapse of necrotic area, the results were satisfactory in the near future.