青壮年人群早期股骨头坏死治疗策略的选择

Selection of Treatment Strategy for Early Femoral Head Necrosis in Young and Middle-aged Population

股骨头坏死是一种常发生于青壮年人群的高致残性疾病。在股骨头塌陷前的早期阶段,通常选用保留髋关节的手术治疗,但保髋治疗的手术方式很多,如何恰当的选择治疗方式是医生必须面对的难题。"血液循环障碍"是股骨头坏死的共同病理特征,保髋手术的出发点就是要解决这一问题,其理想的手术方式需要实现以下四个治疗目标:去除死骨和纤维肉芽组织,改善股骨头血液循环,提供结构支撑,促进新骨生成。在当前的技术条件下,"病灶清除+有血运的骨移植术"能够同时实现这四个治疗目标,成为治疗青壮年人群早期股骨头坏死的理想方式,其中又以"病灶清除+带血管蒂的髂骨移植术"为最佳。

Femoral head necrosis is a highly disabling disease that often occurs in young and middle-aged people.In the early stage before the collapse of the femoral head,the hip preservation surgery is usually used,but there are many ways to treat the hip preservation.How to choose the appropriate treatment is a difficult problem that the doctor must face."Blood circulation disorder"is the common pathological characteristic of femoral head necrosis.The starting point of hip preservation surgery is to solve this problem.The ideal operation method needs to achieve the following four treatment objectives:removing dead bone and fibrous granulation tissue,improving femoral head blood circulation,providing structural support,promoting new bone formation.Under current technical conditions,bone transplantation with debridement and blood delivery can achieve these four treatment goals simultaneously and become an ideal way to treat early femoral head necrosis in young and middle-aged people.Among them,iliac bone transplantation with vascular pedicle was the best.