股骨头坏死保髋治疗现状

Current Situation of Hip Preserving Treatment of Femoral Head Osteonecrosis

股骨头坏死是一种渐进性疾病,终末期可导致股骨头塌陷,髋关节功能受限,此期行人工髋关节置换术是最有效的治疗方法,并可达到满意的效果,但年轻患者远期面临翻修手术风险,因而早期干预是保髋的关键。限制负重、改变生活方式、口服药物以及物理治疗可用于早期病变较小的患者,通常非手术治疗不是很有效,大部分患者选择手术治疗,以减轻疼痛,提高生活质量。保髋术式较多,如髓芯减压术、骨移植术、截骨术、钽棒植入术、骨髓间充质干细胞植入术等,其中髓芯减压术最常用,骨髓间充质干细胞植入术最有潜力。由于每种术式都有利弊,临床医师常联合使用,效果显著。

Osteonecrosis of the femoral head is a progressive disease,which leads to the collapse of the femoral head and restrictive hip joint function in its terminal stage.Total hip arthroplasty is the first choice that could optimize the effect at this stage,but the risk of revision surgery will be faced by young patients in the long run.Therefore,early intervention is crucial for saving the hip.Limiting weight-bearing,adjusting lifestyle,oral meditation and physiotherapy are all optional for early milder patients.However,non-surgical treatments are not always effective.Most patients tend to choose surgery to release pain and improve the quality of life.There are many hip-preserving procedures,such as core decompression,bone grafting,osteotomy,tantalum rod implantation,bone marrow mesenchymal stem cell implantation,and so on.Among these procedures,core decompression is most commonly used,bone marrow mesenchymal stem cell implantation is the most promising.Every procedure has its benefits and risks,so they are usually combined to achieve the most satisfactory effect.