Operative technique and results of core decompression and filling with bone grafts in the treatment of osteonecrosis of femoral head.

BACKGROUND: The aim of this paper is to present the operative technique and results of core decompression and clearing of a necrotic zone in the femoral head followed by filling the defect with impacted autologous or synthetic bone grafts. This procedure allows for mechanical prevention of further collapse of the femoral head and loss of its spherical shape. It also creates conditions for the incorporation of the biological graft or synthetic bone. MATERIALS AND METHODS: A series of 63 patients (72 hips) were treated for aseptic osteonecrosis of the femoral head between 1996 and 2009. This group comprised 42 men and 21 women aged 19 to 60 years (average age: 35 years). Radiographic staging of necrosis was based on the ARCO (Association Research Circulation Osseous) classification. All patients were treated with core decompression followed by filling the bone defect with autologous or synthetic (Wright ProDense) bone grafts. RESULTS: Average follow-up was 5 years (from 1 to 12 years). After one year of follow-up, pain relief with preservation of a spherical femoral head was obtained in 45 hips (63%). Sixteen hips (22%) had significant limitation of the range of motion that, however, did not exceed preoperative values, with no significant pain during walking, and loss of the spherical shape of the femoral head on radiographs. CONCLUSIONS: Filling the defect with morsellized or synthetic bone grafts followed by graft impaction creates mechanical and biological conditions for graft incorporation. Where collapse has not occurred during the first six post-operative months, a good and lasting result can be expected.

Gynaecological operation as an objective stressor in women.

OBJECTIVES: The purpose of the study was to verify the usefulness of Number Scale of 0-10 points (used to assess pain) and the concentration of prolactin (PRL) in the blood serum for the evaluation of stress in patients undergoing surgical intervention on gynaecological wards. MATERIAL AND METHODS: The study was carried out among 200 patients with different gynaecological illnesses operated in The Department of Reproduction and Andrology Skubiszewski Medical University of Lublin. The study used a questionnaire and Medical Documentation Analysis Sheet, especially constructed for the purpose of study, and Numerical Scale 0-10 to self-evaluate the stress level. Moreover, prolactin (PRL) concentration as a marker of stress reaction in the blood serum has been evaluated as well. The differences were determined by U Mann-Whitney and Kruskal-Wallis tests. Wilcoxon's test was used to compare the parameters examined on two levels in dependent groups. The calculations assumed 5% conclusion error and p<0.05 as statistically significant different. RESULTS: The patients reported higher stress prior to the operation than after it (p<0.001). PRL concentrations were significantly higher in the patients after the operation (p<0.001). No correlation between subjective level of stress and PRL concentrations before operation (p=0.254) have been found. The patients who reported higher stress had higher PRL concentrations in the postoperative period. The highest PRL concentrations were observed in the patients who underwent laparoscopy and laparoscopy with hysteroscopy and the lowest values were noted among the patients after hysteroscopy. CONCLUSIONS: Surgical intervention was perceived by women as stressful, disregarding the type and extent of an operation. Patients' subjective evaluation revealed higher stress level before the operation while they were waiting for the surgery. Contrary to that, prolactin concentration was higher in the first day after the surgery. Therefore, prolactin was not an objective marker of psychological stress in the examined group. Trauma caused by surgical intervention as a biological stressor induced an increased prolactin concentration in blood serum during the postoperative period.