股骨头坏死(osteonecrosis of the femoral head,ONFH)是临床常见的难治性疾病。虽然其确切的病理生理机制尚不完全清楚,但普遍认为与骨内循环中断和最终骨组织死亡紧密相关。股骨头坏死的预防和保头治疗一直是临床骨科医生面临的巨大...股骨头坏死(osteonecrosis of the femoral head,ONFH)是临床常见的难治性疾病。虽然其确切的病理生理机制尚不完全清楚,但普遍认为与骨内循环中断和最终骨组织死亡紧密相关。股骨头坏死的预防和保头治疗一直是临床骨科医生面临的巨大挑战。为进一步规范ONFH的诊断和治疗,2020版指南在"中国成人股骨头坏死诊疗指南(2016)"的基础上,对ONFH的流行病学、病因学、病理生理学、影像学、诊断和治疗的新进展等方面进行了修订和更新。国际骨循环研究学会(The Association Research Circulation Osseous,ARCO)制订的股骨头坏死分期在指导治疗、判断预后、评估疗效等方面广泛应用,最新的ARCO分期系统(2019版)也引入指南中。指南不仅建立了ONFH的基本诊断、治疗和评价体系,还提供了流行病学、病因学、诊断标准、病理分期、预防和治疗选择(包括中医药治疗)以及术后康复等方面的专家意见和标准。根据不同阶段骨坏死的骨内血供变化,推荐相应的非手术治疗和手术治疗;存在ONFH的可能危险因素时,建议采取一定的预防措施以避免股骨头坏死的发生。指南为骨坏死提供了简要的分类标准和治疗方案。明确病因、综合考虑不同阶段股骨头坏死的血运状态、髋关节功能、患者的年龄和职业是诊断和制定治疗策略的重要步骤。展开更多
股骨头坏死（osteonecrosis of the femoral head,ONFH）是好发于30-50岁中青年的难治性疾病,与激素应用、酗酒和髋部创伤等多种因素有关。ONFH后期发生股骨头塌陷、髋关节功能障碍,严重影响中青年患者的身心健康。人工全髋关节置换术...股骨头坏死（osteonecrosis of the femoral head,ONFH）是好发于30-50岁中青年的难治性疾病,与激素应用、酗酒和髋部创伤等多种因素有关。ONFH后期发生股骨头塌陷、髋关节功能障碍,严重影响中青年患者的身心健康。人工全髋关节置换术是世界公认治疗髋关节病痛的有效方法,但远期必然面临翻修、再翻修的现实。因此,在ONFH的早期阶段,保留患者自身髋关节具有很高的临床和社会价值。展开更多
Objective： To evaluate the clinical efficacy and safety of the treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell （BMCs） infusion. Methods： 44...Objective： To evaluate the clinical efficacy and safety of the treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell （BMCs） infusion. Methods： 44 hips in 28 patients with avascular necrosis at early stage were treated by percutaneous multiple holes decompression followed by autologous BMCs infusion. Autologous BMCs were concentrated from bone marrow that was taken from the posterior iliac crest of the patient. Patients were followed up at least 2 years. The results were determined by the changes in the Harris hip score and the progression in the radiograghic stages. Results： No complications were observed after the operation. Before operation, there were stage Ⅰ of femoral head necrosis in 8 hips, stage Ⅱin 15 hips, stage Ⅲin 14 hips, stage Ⅳ in 7 hips, and the postoperative stages at the most recent follow-up were stage O in 1 hip, stage Ⅰ in 6 hips, stage Ⅱin 13 hips, stage Ⅲin 13 hips, stage Ⅳ in 7 hips, stage Ⅴ in 4 hips. The mean preoperative Harris hip score was 58 （ 46-89 ）, and improved to 86 （ 70-94 ） postoperatively. All the femoral head collapsed preoperatively showed that the necrotic size was at least more than 30 %. Conclusions ： Percutaneous multiple holes decompression combined with autologous BMCs is a new way to treat avascular necrosis of the femoral head. The earlier the stage, the better the result. A randomized prospective study needed to compare with routine core decompression in the future.展开更多
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...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。展开更多
文摘股骨头坏死(osteonecrosis of the femoral head,ONFH)是临床常见的难治性疾病。虽然其确切的病理生理机制尚不完全清楚,但普遍认为与骨内循环中断和最终骨组织死亡紧密相关。股骨头坏死的预防和保头治疗一直是临床骨科医生面临的巨大挑战。为进一步规范ONFH的诊断和治疗,2020版指南在"中国成人股骨头坏死诊疗指南(2016)"的基础上,对ONFH的流行病学、病因学、病理生理学、影像学、诊断和治疗的新进展等方面进行了修订和更新。国际骨循环研究学会(The Association Research Circulation Osseous,ARCO)制订的股骨头坏死分期在指导治疗、判断预后、评估疗效等方面广泛应用,最新的ARCO分期系统(2019版)也引入指南中。指南不仅建立了ONFH的基本诊断、治疗和评价体系,还提供了流行病学、病因学、诊断标准、病理分期、预防和治疗选择(包括中医药治疗)以及术后康复等方面的专家意见和标准。根据不同阶段骨坏死的骨内血供变化,推荐相应的非手术治疗和手术治疗;存在ONFH的可能危险因素时,建议采取一定的预防措施以避免股骨头坏死的发生。指南为骨坏死提供了简要的分类标准和治疗方案。明确病因、综合考虑不同阶段股骨头坏死的血运状态、髋关节功能、患者的年龄和职业是诊断和制定治疗策略的重要步骤。
文摘股骨头坏死（osteonecrosis of the femoral head,ONFH）是好发于30-50岁中青年的难治性疾病,与激素应用、酗酒和髋部创伤等多种因素有关。ONFH后期发生股骨头塌陷、髋关节功能障碍,严重影响中青年患者的身心健康。人工全髋关节置换术是世界公认治疗髋关节病痛的有效方法,但远期必然面临翻修、再翻修的现实。因此,在ONFH的早期阶段,保留患者自身髋关节具有很高的临床和社会价值。
文摘Objective： To evaluate the clinical efficacy and safety of the treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell （BMCs） infusion. Methods： 44 hips in 28 patients with avascular necrosis at early stage were treated by percutaneous multiple holes decompression followed by autologous BMCs infusion. Autologous BMCs were concentrated from bone marrow that was taken from the posterior iliac crest of the patient. Patients were followed up at least 2 years. The results were determined by the changes in the Harris hip score and the progression in the radiograghic stages. Results： No complications were observed after the operation. Before operation, there were stage Ⅰ of femoral head necrosis in 8 hips, stage Ⅱin 15 hips, stage Ⅲin 14 hips, stage Ⅳ in 7 hips, and the postoperative stages at the most recent follow-up were stage O in 1 hip, stage Ⅰ in 6 hips, stage Ⅱin 13 hips, stage Ⅲin 13 hips, stage Ⅳ in 7 hips, stage Ⅴ in 4 hips. The mean preoperative Harris hip score was 58 （ 46-89 ）, and improved to 86 （ 70-94 ） postoperatively. All the femoral head collapsed preoperatively showed that the necrotic size was at least more than 30 %. Conclusions ： Percutaneous multiple holes decompression combined with autologous BMCs is a new way to treat avascular necrosis of the femoral head. The earlier the stage, the better the result. A randomized prospective study needed to compare with routine core decompression in the future.
文摘股骨头坏死(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。
