国内股骨头坏死保留髋关节手术治疗的十年回顾

Past decade on hip-preserving surgery for osteonecrosis of femoral head treatment in China

股骨头坏死（osteonecrosis of femoral head，ONFH）是骨科常见病，好发于中青年。因人工关节假体有一定的使用寿命，且髋关节翻修术的手术难度高、风险高、并发症多，所以保留髋关节的手术越来越受到重视。目前临床上应用的保留髋关节的手术方法众多，但疗效不确切。髓芯减压术与打压植骨术方法简单，可减轻股骨头内压力、缓解疼痛，但无法彻底清除坏死骨，因此仅应用于早期ONFH。血管化骨移植术的应用填补了前者的缺陷，不但能够彻底清除坏死骨，还可以为股骨头提供有滋养血管的移植骨，有利于股骨头内骨结构的重建。钽棒的应用为股骨头提供了力学支撑，具有预防股骨头塌陷的作用。干细胞移植技术的出现为ONFH的保留髋关节手术提供了新的思路，该技术常配合其他术式，利用干细胞增殖分化能力强的特点促进骨细胞再生，辅助股骨头修复。近十年来，保留髋关节手术开展越来越多，临床疗效也不断得到改善，多种术式相互结合为ONFH提供了更多的治疗选择。但无论选择何种术式，保留髋关节手术的理念始终是在保证疗效的前提下尽可能选择手术创伤小、方法简单、对髋关节骨结构损伤不大的手术方案。

As a common disease in orthopedics, osteonecrosis of the femoral head （ONFH） frequently occurs among young and middle-aged people. Hip joint preserving surgery has attracted more and more attention due to the fact that artificial joint prosthesis has a certain useful life and the rate of hip joint revision is high and the higher risk of many complications. There are a large number of operative methods for preserving hip joint in clinical practice without definitive curative effects. Core decompression and impaction bone grafting with simple operative methods can relieve internal pressure of femoral head and pain symptoms, but they cannot remove necrotic bone completely. Hence, they are only used for ONFH in the early stage. Vascularized bone transplantation can fill defects of the former, as it can not only completely remove necrotic bone, but also provide bone graft with nourishing vessels for femoral head, being beneficial to reconstruct the bone structure of femoral head. Subsequently, the application of tantalum rod can provide mechanical support for femoral head to prevent the collapse of femoral head. The emergence of stem cell trans- plantation has created a new approach to preserve hip joint for ONFH, which promotes the regeneration of bone cells and assists femoral head in repair, often combined with other operative methods and using characteristics of superior proliferation and differentiation of stem cells. Hip joint preserving surgery, in recent years, has been performed increasingly, and has obtained improvement in clinical effects. The multiple combination of a variety of its operative methods provides more effective treatments for ONFH. It is an essential notion that hip joint preserving surgery, however with any operative method, should as far as possible select a surgi- cal plan with little trauma, simple methods and little injury to bone structure of hip joint based on ensuring the efficacy.