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 п║п©п╟я│п╦п╠п╬,п╨п╬п╩п╩п╣пЁп╦


п║я─п╣п╢п╟, 30 я▐п╫п╡п╟я─я▐ 2013, 20:48 +06:00 п╬я┌ "Djoldas Kuldjanov, M.D." <orthoforum на weborto.net>:
>AVN. п║п╦п╫п╬п╫п╦п╪я▀: п╦я┬п╣п╪п╦я┤п╣я│п╨п╦п╧ п╨п╬я│я┌п╫я▀п╧ п╫п╣п╨я─п╬п╥, п╨п╬я│я┌п╫я▀п╧ п╦п╫я└п╟я─п╨я┌, п╨п╬я│я┌п╫я▀п╧ 
>п╫п╣п╨я─п╬п╥, п╟я│п╣п©я┌п╦я┤п╣я│п╨п╦п╧ п╫п╣п╨я─п╬п╥.
>п▓п╬п╥п╪п╬п╤п╫п╬ я│п╬п╪п╫п╣п╫п╦я▐ п╡ п╢п╦п╟пЁп╫п╬я│я┌п╦п╨п╣ я│п╡я▐п╥п╟п╫я▀ я│ п╫п╣я┌п╦п©п╦я┤п╫п╬п╧ я─п╣п╫я┌пЁп╣п╫п╬п╩п╬пЁп╦я┤п╣я│п╨п╬п╧ 
>п╨п╟я─я┌п╦п╫п╬п╧. п²п╟ я│п╫п╦п╪п╨п╣ п╠п╬п╩я▄я┬п╟я▐ п╨п╦я│я┌п╟, п╨п╬я┌п╬я─п╟я▐ я─п╟я│п©п╬п╩п╬п╤п╣п╫п╟ п╡ я├п╣п╫я┌я─п╣ пЁп╬п╩п╬п╡п╨п╦, 
>п╟ п©я─п╦ п░п▓п² п╫п╟я┤п╦п╫п╟п╣я┌я│я▐ п╡ п╡п╣я─я┘п╫п╣п╧ п╫п╟пЁя─я┐п╥п╬я┤п╫п╬п╧ п╥п╬п╫п╣. п·я┌я│я┐я┌я│я┌п╡я┐п╣я┌ п╨п╬п╩п╩п╟п©я│, 
>я│п╬я┘я─п╟п╫п╦п╩п╟я│я▄ я│я└п╣я─п╦я┤п╫п╬я│я┌я▄ пЁп╬п╩п╬п╡п╨п╦; п╫п╣ п╬я┤п╣п╫я▄ п╡я▀я─п╟п╤п╣п╫п╫я▀п╧, п╫п╬ я┘п╟я─п╟п╨я┌п╣я─п╫я▀п╧ 
>п©я─п╦п╥п╫п╟п╨  "Crescent Sign".
>п■п╦я└я└п╣я─п╫я├п╦п╟п╩я▄п╫я┐я▌ п╢п╦п╟пЁп╫п╬я│я┌п╦п╨я┐ п╫п╟п╢п╬ п╢п╣п╩п╟я┌я▄ я│ п╢п╬п╠я─п╬п╨п╟я┤п╣я│я┌п╡п╣п╫п╫п╬п╧ п╨п╦я│я┌п╬п╧ п╦п╩п╦ 
>п╪п╣я┌п╟я│я┌п╟п╥п╟п╪п╦. п²п╬ п╢п╡я┐я┘я│я┌п╬я─п╣п╫п╫п╟я▐ п╨п╦я│я┌п╟ п╡я│я┌я─п╣я┤п╟п╣я┌я│я▐ п╬я┤п╣п╫я▄ я─п╣п╢п╨п╬, п╦ п╨п╦я│я┌п╟ п╡ 
>я┬п╣п╧п╨п╣ я─п╟я│п©п╬п╩п╬пЁп╟п╣я┌я│я▐ п╠п╬п╩п╣п╣ п╢п╦я│я┌п╟п╩я▄п╫п╬, я┤п╣п╪ п©я─п╦ п░п▓п². п⌠п╣я┌п╣я─п╬пЁп╣п╫п╫п╟я▐ п╨п╟я─я┌п╦п╫п╟ 
>пЁп╬п╩п╬п╡п╨п╦ п╫п╣п╪п╫п╬пЁп╬ п╫п╟п©п╬п╪п╦п╫п╟п╣я┌ п╪п╣я┌п╟я│я┌п╟п╥, п╫п╬ п╠п╣п╥ п©п╣я─п╡п╦я┤п╫п╬п╧ п╬п©я┐я┘п╬п╩п╦ п╦ п╥п╟я┌я▐п╤п╫п╬п╧ 
>я┘п╟я─п╟п╨я┌п╣я─ я┌п╣я┤п╣п╫п╦я▐ п╥п╟п╠п╬п╩п╣п╡п╟п╫п╦я▐ я│п╫п╦п╪п╟п╣я┌ п©п╬п╢п╬п╥я─п╣п╫п╦п╣ п╫п╟ п╥п╩п╬п╨п╟я┤п╣я│я┌п╡п╣п╫п╫я▀п╧ п©я─п╬я├п╣я│я│.
>п÷я─п╦ п╫п╟п╩п╦я┤п╦п╦ п╨п╬п╩п╩п╟п©я│п╟ п╢п╦п╟пЁп╫п╬п╥ я┐я│я┌п╟п╫п╟п╡п╦я┌я▄ п╬я┤п╣п╫я▄ п╩п╣пЁп╨п╬. п║п╨п╟п╫п╦я─п╬п╡п╟п╫п╦п╣ я│ 
>п╦п╥п╬я┌п╬п©п╟п╪п╦ я┌п╬п╤п╣ я┘п╬я─п╬я┬п╦п╧ п╪п╣я┌п╬п╢ п╦я│я│п╩п╣п╢п╬п╡п╟п╫п╦я▐, п╨п╬я┌п╬я─я▀п╧ п©п╬п╨п╟п╤п╣я┌ "я┘п╬п╩п╬п╢п╫я▀п╣" 
>я┐я┤п╟я│я┌п╨п╦,  п╬п╨я─я┐п╤п╣п╫п╫я▀п╣ "я┌п╣п©п╩я▀п╪п╦" п╥п╬п╫п╟п╪п╦. п≤я│я│п╩п╣п╢п╬п╡п╟п╫п╦п╣ п╡ 25% п╢п╟п╣я┌ 
>п©п╬пЁя─п╣я┬п╫п╬я│я┌я▄, п╦ п©п╬я█я┌п╬п╪я┐ п╫п╟ я│п╣пЁп╬п╢п╫я▐ п°п═п╒ я▐п╡п╩я▐п╣я┌я│я▐ "п╥п╬п╩п╬я┌я▀п╪ я│я┌п╟п╫п╢п╟я─я┌п╬п╪" 
>п╦я│я│п╩п╣п╢п╬п╡п╟п╫п╦я▐. п÷я┐п╫п╨я├п╦я▐ п╫п╣ п©п╬п╪п╣я┬п╟п╣я┌, п╫п╬ п╪п╫п╣ п╨п╟п╤п╣я┌я│я▐, я┤я┌п╬ п╥п╢п╣я│я▄ п©п╬ 
>п╨п╩п╟я│я│п╦я└п╦п╨п╟я├п╦п╦ Ficat п©я─п╣п╨п╬п╩п╩п╟п©я│п╫я▀п╧, я┌.п╣. п╡я┌п╬я─п╟я▐ я│я┌п╣п©п╣п╫я▄ п░п▓п².
>п░п▓п² п©я─п╬пЁя─п╣я│я│п╦п╡п╫п╬п╣ п╥п╟п╠п╬п╩п╣п╡п╟п╫п╦п╣, я┤п╣п╪ я─п╟п╫я▄я┬п╣ п╩п╣я┤п╣п╫п╦п╣, я┌п╣п╪ п╩я┐я┤я┬п╣ я─п╣п╥я┐п╩я▄я┌п╟я┌я▀. 
>п÷я─п╣п╢п╩п╬п╤п╣п╫я▀ я─п╟п╥п╫я▀п╣ п╪п╣я┌п╬п╢я▀ п╩п╣я┤п╣п╫п╦я▐ п╫п╟я┤п╦п╫п╟я▐ п╬я┌ Core Decompression, 
>Non-vascular bone graft, Free vascularized fibular graft, Osteotomies, 
>Resurfacing Arthroplasty, Total hip arthroplasty.
>Core Decompression п╢п╩я▐ п╡п╬я│я│я┌п╟п╫п╬п╡п╩п╣п╫п╦я▐ п╡п╫я┐я┌я─п╦-п╨п╬я│я┌п╫п╬пЁп╬ п╨я─п╬п╡п╬п╬п╠я─п╟я┴п╣п╫п╦п╣, п╦ 
>я─п╣п╨п╬п╪п╣п╫п╢я┐п╣я┌я│я▐ п©я─п╦ п©я─п╣п╨п╬п╩п╩п╟п©я│п╫п╬п╪ п©п╣я─п╦п╬п╢п╣. п▓ 70% п╢п╟п╣я┌ п©п╬п╩п╬п╤п╦я┌п╣п╩я▄п╫я▀п╧ 
>я─п╣п╥я┐п╩я▄я┌п╟я┌ п╡ я│я┌п╟п╢п╦я▐я┘ п╥п╟п╠п╬п╩п╣п╡п╟п╫п╦я▐ п╬я┌ 1 п╢п╬ 3. п⌡я┐я┤я┬п╣ п©п╬п╩я┐я┤п╟п╣я┌я│я▐ я│ 
>п╟п╩п╩п╬пЁя─п╟я└я┌п╬п╪, DBM, п╒п╟п╫я┌п╟п╩п╬п╡я▀п╣ п╦п╩п╦ п╨п╬я│я┌п╫я▀п╪п╦ п╥п╟п╪п╣п╫п╦я┌п╣п╩я▐п╪п╦.
>Stulberg et al. Osteonecrosis of the Femoral Head: A  prospective 
>randomized treatment protocol. CORR 1991;268:140-151
>Mont MA, Carbone JJ, Fairbanks AC. Core decompression versus 
>non-operative management for osteonecrosis of the hip COORR 1996; 
>324:169-178 Mont et al
>Reviewed 42 studies (1960-1993):1,206 total hips treated with core 
>decompression, 819 with non-operative.Successful results in:Prior to 
>collapse 71% success with core decompression. 35% success with 
>conservative treatment. 63% success rate overall
>п·я┌ п╬я│я┌п╣п╬я┌п╬п╪п╦п╦ п╩я┐я┤я┬п╦п╧ я─п╣п╥я┐п╩я▄я┌п╟я┌ п©п╬п╩я┐я┤п╟п╣я┌я│я▐, п╨п╬пЁп╢п╟ п╦п╪п╣я▌я┌я│я▐ п╪п╦п╫п╦п╪п╟п╩я▄п╫я▀п╣ 
>я│я┐я│я┌п╟п╡п╫я▀п╣ п╦п╥п╪п╣п╫п╣п╫п╦я▐, я│я─п╟п╡п╫п╦я┌п╣п╩я▄п╫п╬ п╫п╣п╠п╬п╩я▄я┬п╬п╧ я┐я┤п╟я│я┌п╬п╨ п╫п╣п╨я─п╬п╥п╟, п╟ я┌п╟п╨п╤п╣ п╫п╣ 
>я│я┌п╟я─я┬п╣ 45-п╩п╣я┌п╫п╣пЁп╬ п╡п╬п╥я─п╟я│я┌п╟.  п■я─я┐пЁп╦п╣ п╡п╟я─п╦п╟п╫я┌я▀ п╩п╣я┤п╣п╫п╦я▐  - Resurfacing п╦ 
>THA - п╬п©я┌п╦п╪п╟п╩я▄п╫я▀  п©п╬я│п╩п╣ п╨п╬п╩п╩п╟п©я│п╫п╬пЁп╬ п░п▓п².
>Djoldas Kuldjanov, M.D.
>
>
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