青壮年人群早期股骨头坏死治疗策略的选择(1)
摘 要：股骨头坏死是一种常发生于青壮年人群的高致残性疾病。在股骨头塌陷前的早期阶段，通常选用保留髋关节的手术治疗，但保髋治疗的手术方式很多，如何恰当的选择治疗方式是医生必须面对的难题。“血液循环障碍”是股骨头坏死的共同病理特征，保髋手术的出发点就是要解决这一问题，其理想的手术方式需要实现以下四个治疗目标：去除死骨和纤维肉芽组织，改善股骨头血液循环，提供结构支撑，促进新骨生成。在当前的技术条件下，“病灶清除+有血运的骨移植术”能够同时实现这四个治疗目标，成为治疗青壮年人群早期股骨头坏死的理想方式，其中又以“病灶清除+带血管蒂的髂骨移植术”为最佳。
关键词：股骨头坏死；青壮年；保髋治疗；带蒂髂骨块移植
中图分类号：R687.3 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.08.003
文章编号：1006-1959(2018)08-0010-04
, 百拇医药
Selection of Treatment Strategy for Early Femoral Head Necrosis in Young and Middle-aged Population
PAN Feng-yu，ZHANG Yong-quan
(Department of Joint Surgical，107th PLA Hospital，Yantai 264002，Shandong，China)
Abstract：Femoral head necrosis is a highly disabling disease that often occurs in young and middle-aged people.In the early stage before the collapse of the femoral head，the hip preservation surgery is usually used，but there are many ways to treat the hip preservation.How to choose the appropriate treatment is a difficult problem that the doctor must face."Blood circulation disorder"is the common pathological characteristic of femoral head necrosis.The starting point of hip preservation surgery is to solve this problem.The ideal operation method needs to achieve the following four treatment objectives：removing dead bone and fibrous granulation tissue，improving femoral head blood circulation，providing structural support，promoting new bone formation.Under current technical conditions，bone transplantation with debridement and blood delivery can achieve these four treatment goals simultaneously and become an ideal way to treat early femoral head necrosis in young and middle-aged people.Among them，iliac bone transplantation with vascular pedicle was the best.
, 百拇医药
Key words：Osteonecrosis of femoral head；Young adults；Hip preservation therapy；Iliac bone graft with pedicle
股骨头坏死(osteonecrosis of the femoral head，ONFH)属于缺血性骨坏死，是指股骨头血供中断或受损，引起骨细胞、骨髓造血细胞和脂肪细胞(即骨的活性成分)死亡及修复的病理过程，疾病进展将导致关节软骨的破坏、股骨头塌陷、髋关节功能丧失。股骨头坏死的致残率较高，是骨科领域的难治性疾病之一[1]。由于目前早期股骨头坏死的治疗效果并不十分理想，许多患者最终进展至股骨头塌陷的晚期阶段[2]，不得不接受髋关节置换手术，给患者带来巨大的身心痛苦和经济负担。近年来，青壮年发生股骨头缺血坏死有逐渐增多的趋势。因此，针对该类患者人群，如何在股骨头坏死的早期阶段选择恰当的治疗方案，这是一个值得临床医生深入探讨的课题。
股骨头坏死的确诊并不困难，通过患者的临床症状、体症和影像学检查通常可以做出明确诊断。股骨头坏死有多种分期方法，目前临床常用的为Ficat分期法和ARCO分期法(国际分期法)。依据ARCO分期法，一般认为0～Ⅱ为早期，Ⅲ为中期，Ⅳ为晚期。在临床实践中，医生为了简化分期，常常把“股骨头是否塌陷”作为一个重要标识，用来评估股骨头坏死的严重程度，并以此为依据来选择治疗方式。为了叙述清晰简洁，本文所叙述的早期股骨头坏死同样是指股骨头壞死的未塌陷时期，主要对应的是ARCO分期中的Ⅱ期，可以略扩大至股骨头略有塌陷的Ⅲ-A期。
目前对股骨头坏死通常采取综合治疗和阶梯治疗策略。治疗的首要原则是去除致病因素，并在此基础上，针对股骨头坏死的不同分期，选择相应的治疗策略。疾病发展的不同阶段对应着不同的治疗方案。, 百拇医药(潘风雨 张涌泉)
关键词：股骨头坏死；青壮年；保髋治疗；带蒂髂骨块移植
中图分类号：R687.3 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.08.003
文章编号：1006-1959(2018)08-0010-04
, 百拇医药
Selection of Treatment Strategy for Early Femoral Head Necrosis in Young and Middle-aged Population
PAN Feng-yu，ZHANG Yong-quan
(Department of Joint Surgical，107th PLA Hospital，Yantai 264002，Shandong，China)
Abstract：Femoral head necrosis is a highly disabling disease that often occurs in young and middle-aged people.In the early stage before the collapse of the femoral head，the hip preservation surgery is usually used，but there are many ways to treat the hip preservation.How to choose the appropriate treatment is a difficult problem that the doctor must face."Blood circulation disorder"is the common pathological characteristic of femoral head necrosis.The starting point of hip preservation surgery is to solve this problem.The ideal operation method needs to achieve the following four treatment objectives：removing dead bone and fibrous granulation tissue，improving femoral head blood circulation，providing structural support，promoting new bone formation.Under current technical conditions，bone transplantation with debridement and blood delivery can achieve these four treatment goals simultaneously and become an ideal way to treat early femoral head necrosis in young and middle-aged people.Among them，iliac bone transplantation with vascular pedicle was the best.
, 百拇医药
Key words：Osteonecrosis of femoral head；Young adults；Hip preservation therapy；Iliac bone graft with pedicle
股骨头坏死(osteonecrosis of the femoral head，ONFH)属于缺血性骨坏死，是指股骨头血供中断或受损，引起骨细胞、骨髓造血细胞和脂肪细胞(即骨的活性成分)死亡及修复的病理过程，疾病进展将导致关节软骨的破坏、股骨头塌陷、髋关节功能丧失。股骨头坏死的致残率较高，是骨科领域的难治性疾病之一[1]。由于目前早期股骨头坏死的治疗效果并不十分理想，许多患者最终进展至股骨头塌陷的晚期阶段[2]，不得不接受髋关节置换手术，给患者带来巨大的身心痛苦和经济负担。近年来，青壮年发生股骨头缺血坏死有逐渐增多的趋势。因此，针对该类患者人群，如何在股骨头坏死的早期阶段选择恰当的治疗方案，这是一个值得临床医生深入探讨的课题。
股骨头坏死的确诊并不困难，通过患者的临床症状、体症和影像学检查通常可以做出明确诊断。股骨头坏死有多种分期方法，目前临床常用的为Ficat分期法和ARCO分期法(国际分期法)。依据ARCO分期法，一般认为0～Ⅱ为早期，Ⅲ为中期，Ⅳ为晚期。在临床实践中，医生为了简化分期，常常把“股骨头是否塌陷”作为一个重要标识，用来评估股骨头坏死的严重程度，并以此为依据来选择治疗方式。为了叙述清晰简洁，本文所叙述的早期股骨头坏死同样是指股骨头壞死的未塌陷时期，主要对应的是ARCO分期中的Ⅱ期，可以略扩大至股骨头略有塌陷的Ⅲ-A期。
目前对股骨头坏死通常采取综合治疗和阶梯治疗策略。治疗的首要原则是去除致病因素，并在此基础上，针对股骨头坏死的不同分期，选择相应的治疗策略。疾病发展的不同阶段对应着不同的治疗方案。, 百拇医药(潘风雨 张涌泉)