成人股骨头坏死保髋手术治疗的策略及探讨

Strategy and discussion of hip joint preserving surgery treatments for adult osteonecrosis of the femoral head

股骨头坏死(osteonecrosis of the femoral head,ONFH)是骨科常见病,好发于中青年人。因人工关节假体有一定的使用寿命,且髋关节翻修术难度较高、风险较大、并发症较多,所以保留髋关节手术越来越受到重视。目前临床上应用的保髋手术方法较多,但疗效不确切。关于如何在恰当的时机选择恰当的手术方式的认识也在不断更新,明确ONFH病理发展过程有助于选择恰当的ONFH保髋手术方式。早期的髓芯减压术与打压植骨术方法简便,可减轻股骨头内压力、缓解疼痛,但无法彻底清除坏死骨,仅应用于早期ONFH。血管化骨移植术的应用填补了前者缺陷,不仅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。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保髋治疗提供了更多选择。但无论采用何种术式,保髋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、方法简便、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 effectiveness. How to choose appropriate surgical methods at the right time is also a continuous understanding.The pathological process of necrosis of the femur helps to choose the choice of the femoral head necrosis for the treatment of hip operation. 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. 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 surgical plan with little trauma, simple methods, and little injury of hip joint bone structure based on ensuring the effectiveness.