Core decompression for early-stage avascular necrosis of the humeral head: current concepts and techniques.

IF 1.8 Q2 ORTHOPEDICS
Michael D Scheidt, Saleh Aiyash, Dane Salazar, Nickolas Garbis
{"title":"Core decompression for early-stage avascular necrosis of the humeral head: current concepts and techniques.","authors":"Michael D Scheidt,&nbsp;Saleh Aiyash,&nbsp;Dane Salazar,&nbsp;Nickolas Garbis","doi":"10.5397/cise.2022.00969","DOIUrl":null,"url":null,"abstract":"<p><p>Avascular necrosis (AVN) of the humeral head is a rare, yet detrimental complication. Left untreated, humeral head AVN frequently progresses to subchondral fracturing and articular collapse. Cases of late-stage humeral head AVN commonly require invasive procedures including humeral head resurfacing, hemiarthroplasty, and total shoulder arthroplasty (TSA) to improve clinical outcomes. However, in cases of early-stage AVN, core decompression of the humeral head is a viable and efficacious short-term treatment option for patients with pre-collapse AVN of the humeral head to improve clinical outcomes and prevent disease progression. Several techniques have been described, however, a percutaneous, arthroscopic-assisted technique may allow for accurate staging and concomitant treatment of intraarticular pathology during surgery, although further long-term clinical studies are necessary to assess its overall outcomes compared with standard techniques. Biologic adjunctive treatments, including synthetic bone grafting, autologous mesenchymal stem cell/bone marrow grafts, and bone allografts are viable options for reducing the progression of AVN to further collapse in the short term, although long-term follow-up with sufficient study power is lacking in current clinical studies. Further long-term outcome studies are required to determine the longevity of core decompression as a conservative measure for early-stage AVN of the humeral head.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":"26 2","pages":"191-204"},"PeriodicalIF":1.8000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4b/9e/cise-2022-00969.PMC10277707.pdf","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinics in Shoulder and Elbow","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5397/cise.2022.00969","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 1

Abstract

Avascular necrosis (AVN) of the humeral head is a rare, yet detrimental complication. Left untreated, humeral head AVN frequently progresses to subchondral fracturing and articular collapse. Cases of late-stage humeral head AVN commonly require invasive procedures including humeral head resurfacing, hemiarthroplasty, and total shoulder arthroplasty (TSA) to improve clinical outcomes. However, in cases of early-stage AVN, core decompression of the humeral head is a viable and efficacious short-term treatment option for patients with pre-collapse AVN of the humeral head to improve clinical outcomes and prevent disease progression. Several techniques have been described, however, a percutaneous, arthroscopic-assisted technique may allow for accurate staging and concomitant treatment of intraarticular pathology during surgery, although further long-term clinical studies are necessary to assess its overall outcomes compared with standard techniques. Biologic adjunctive treatments, including synthetic bone grafting, autologous mesenchymal stem cell/bone marrow grafts, and bone allografts are viable options for reducing the progression of AVN to further collapse in the short term, although long-term follow-up with sufficient study power is lacking in current clinical studies. Further long-term outcome studies are required to determine the longevity of core decompression as a conservative measure for early-stage AVN of the humeral head.

Abstract Image

Abstract Image

Abstract Image

肱骨头早期缺血性坏死的核心减压术:当前的概念和技术。
肱骨头缺血性坏死(AVN)是一种罕见但有害的并发症。如果不及时治疗,肱骨头AVN经常发展为软骨下骨折和关节塌陷。晚期肱骨头AVN通常需要侵入性手术,包括肱骨头置换术、半关节置换术和全肩关节置换术(TSA)来改善临床结果。然而,对于早期AVN,肱骨头前塌陷AVN患者,肱骨头核心减压是一种可行且有效的短期治疗选择,可改善临床结果并预防疾病进展。然而,经皮关节镜辅助技术可能允许手术期间准确分期和伴随治疗关节内病理,尽管需要进一步的长期临床研究来评估其与标准技术相比的总体结果。生物辅助治疗,包括人工骨移植、自体间充质干细胞/骨髓移植和同种异体骨移植,是短期内减少AVN进一步塌陷进展的可行选择,尽管目前的临床研究缺乏足够的长期随访研究。需要进一步的长期结果研究来确定核心减压作为早期肱骨头AVN的保守措施的寿命。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
0.30
自引率
0.00%
发文量
55
审稿时长
15 weeks
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信