股骨头坏死保头治疗现状及预后影响因素的研究进展

股骨头坏死(osteonecrosis of the femoral head,ONFH)是指各种原因所致的股骨头血供受阻导致股骨头骨活性成分死亡,骨坏死发生一死骨吸收一新骨形成是其典型的病变过程。全髋关节置换术(total hip arthroplasty,THA)是绝大多数患者不得不最终选择的治疗方式。尽管ONFH治疗困难,但早期选择合适的保头治疗手段对于延缓THA治疗的时间仍很有必要。目前临床上股骨头坏死保头治疗的手术方式众多,但迄今为止尚无统一的标准。因此,本文就股骨头坏死的流行病学特点、相关危险因素、病理、分期、目前的保头治疗方式以及预后的相关因素进行重点介绍,以进一步增强临床医师对股骨头坏死的认识以及为患者选择更为合适的保头治疗方法提供参考。经文献检索,对我国非创伤性ONFH,男性患病显著高于女性,且以北方居民和城市居民多见,此外糖皮质激素摄入、高脂血症、大量吸烟、酗酒等往往增加了ONFH发生风险;组织学上看,股骨头血供受阻后出现骨成分坏死以及修复的现象;病理分期上,Ficat分期是目前最常用和最直接的分类方法;髓芯减压术、游离骨移植、带血管蒂骨移植、截骨术仍是目前主流的手术方式。患者的年龄、病因、分期等是影响ONFH预后的重要因素,因此术者可根据患者具体病情及影响预后的相关因素酌情选择最为合适的保头治疗方法。

Research progress on current status of head-preserving treatment for osteonecrosis of the femoral head and its prognostic factors

Osteonecrosis of the femoral head(ONFH)is caused by the blockage of the blood supply of the femoral head due to by a variety of reasons,resulting in the death of the bone in the femoral head,which is characterized by osteonecrosis occurdead bone resorption-new bone formation.And total hip arthroplasty(THA)is the final choice for the vast majority of these patients.Though treating hard,it is necessary to choose an appropriate head-preserving treatment in the early stage to delay the time of THA.Methods to treat femoral head necrosis varies,however,it is still hard to have a uniform standard until now.Thus,this paper discusses the epidemiological characteristics,related risk factors,pathology,stage,current head-preserving methods and prognostic factors of femoral head necrosis,so as to further enhance clinicians'understanding of osteonecrosis of the femoral head and provide reference to choose more appropriate head-preserving methods for those patients.As demonstrated in literatures,in China,the incidence of non-traumatic ONFH in males is significantly higher than that in females,and it is more common in northern residents and urban residents.In addition,glucocorticoid intake,hyperlipidemia,heavy smoking and alcohol abuse tend to increase the risk of ONFH;Histologically,osteonecrosis and repair of the femoral head occurred after blood supply was blocked;In terms of pathological staging,Ficat staging is the most commonly used and most directly classification method;core decompression,non-vascularized bone grafting,vascularized bone grafting and osteotomy are still the mainstream surgical methods at present.Patient's age,etiology,stage,etc are important factors affecting the prognosis of ONFH.Therefore,surgeons can choose the most appropriate treatment for the patients according to their specific conditions and prognostic factors.