早中期股骨头坏死的非手术治疗进展

Non-surgical treatment of early and intermediate stages of osteonecrosis of the femoral head

股骨头坏死是一种常发生于中青年人群的髋关节致残性疾病。股骨头坏死的非手术治疗方法包括降脂药、双膦酸盐类、抗凝药物、血管扩张剂等药物治疗和生物物理等疗法。药物治疗是针对股骨头坏死的病因治疗,对减轻早期股骨头坏死疼痛、延缓病情进展有效。体外震波被认为能增加血管生长因子的表达,诱导新生血管形成,促进细胞增生和成骨。非手术疗法主要用于股骨头坏死早中期,临床疗效有待进一步评估。

Osteonecrosis of the femoral head is a disabling clinical entity affecting young adults that usually leads to destruction of the hip joint. Most nonoperative modalities have involved pharmacologic agents such as lipid-clearing agents, bisphosphonates, anticoagulant, vasodilating agent and biophysical. Medical treatments aim at pathogenesis of osteonecrosis of the femoral head, which is effective to relieve pain of early stage osteonecrosis and delaying the progress of the disease. Shockwave treatment is considered induceing the ingrowth of neovascularization associated with increased expressions of angiogenic growth factors, promoting cell proliferation and osteogenesis. Nonoperative treatment usually results in a poor prognosis. However, these methods have no role in treatment of late stage osteonecrosis and clinical efficacy remains to be further evaluated