突发性髋关节坏死的概念及其功能愈后

Concept and functional recovery of rapidly destructive hip disease

目的:认识突发性髋关节坏死的病因以及临床特征,为突发性髋关节坏死患者的功能愈后寻找更有效的治疗技术。资料来源:应用计算机检索Medline1980-01-01/2004-12-31与突发性髋关节坏死相关文献,检索词“rapidly,destructive,hip”限定文章语言种类为English。资料选择:从检索结果中选择部分文献。纳入标准:与突发性髋关节坏死病因、临床诊断及治疗的相关研究。排除标准:综述类文章、Meta分析类文章、重复研究。资料提炼:共检索到26篇关于突发性髋关节坏死的文献,其中14篇与其病因、临床诊断及治疗等有关,排除的12篇为关于该病的同一研究内容的重复结果。资料综合:突发性髋关节坏死为一种非自愈性疾病,其病理改变不但出现在股骨头,也表现在髋臼,X射线的表现常常在短期内进展迅速。突发性髋关节坏死的一个突出特点之一是病程短,早期的X射线可显示骨质疏松及轻微的早期关节炎表现,在较短时期后,患者症状严重加重,患肢缩短,X射线表现为髋关节的全关节严重损害。在诊断方面,可以从患者的病史、主诉、症状、临床检查及实验室检查来排除其他疾病。在早期予保守治疗,同一般的髋关节骨关节病(或股骨头坏死),而一旦浸润严重,可予全髋置换,愈后较好。结论:突发性髋关节坏死以早期髋关节疼痛,短期内迅速出现髋关节破坏,病因尚不明确,缺血可能是主要致病因素之一,临床尚缺乏敏感的早期诊断指标。对关节破坏严重的患者,目前最好的治疗方法是行人工全髋关节置换术。

OBJECTIVE： To comprehend the etiological factors and clinical characteristics of rapidly destructive hip disease（RDHD） and probe into more effective technique for the functional recovery of RDHD in patients. DATA SOURCES： A computer-based search of the articles related to RDHD between January 1, 1980 and December 31, 2004 were performed in Medline database by using the key words “rapidly, destructive, hip”, and the language was limited to English. STUDY SELECTION： Some of the articles were searched according to the inclusion criteria： the studies on the etiological factors, clinical diagnosis and treatment of RDHD,and to the exclusion criteria： reviews,Meta analytic articles and repeated studies. DATA EXTRACTION： Totally 26 articles about RDHD were selected, in which 14 were related to the etiological factors, clinical diagnosis and treatment of RDHD, and 12 were excluded due to the repetitive studies on the similar content of RDHD. DATA SYNTHESIS： RDHD was not a kind of spontaneously cured disease. It had pathological changes in both femoral head and acetabulum, which developed rapidly in a short-term shown by X-ray. Short course is one of the characteristics of RDHD, manifesting as osteoporosis and mild early arthrositis shown by X-ray images; After a short term, the symptoms were aggravated badly and the “affected extremities were shortened, manifesting as severe damage of total hip joints by X-ray images. Concerning the diag-nosis of RDHD, other diseases were excluded according to history, chief complaint, symptoms,clinical examination and laboratory examination.RD-HD could be managed by conservative treatment in its early stage, similar to common osteoarthritis of hip joints or necrosis of the femoral head, how-ever it should be managed by hip replacement for better functional rccov-ery once the infiltration become severer. CONCLUSION： RDHD, which manifests pain of hip joint during the early time, becomes rapid destruction of hip joints in a short time. The etiological factors of RDHD are unclear now, but ischemia may be the essential one, so it is lack of available diagnosis indicators in an early stage for clinical treatment. Up to now, it is the best therapy for the patients who suffer severe destruction of hip joints to perform artificial replacement of total hip.