基于髓芯减压的早期股骨头坏死的保髋治疗策略

Core decompression-based strategies for treatment of the early osteonecrosis of the femoral head

股骨头坏死(ONFH)的治疗目前仍是充满挑战性的科学难题。早期ONFH的治疗目的是缓解症状、改善髋关节功能、延缓疾病的进展,防止股骨头塌陷。以髓芯减压为基础的保髋治疗方法是目前临床上早期ONFH较为有效的治疗策略。过去几十年,大多数的研究提示该治疗策略的临床疗效令人鼓舞,但是仍存在争议。本文将对基于髓芯减压的保髋治疗策略的研究进展进行综述,分别从单孔髓芯减压术(CD)、多孔髓芯减压术(MD)、髓芯减压+非血管化的骨移植(CD+NVBG)、髓芯减压+血管化的骨移植(CD+VBG)、髓芯减压+多孔钽棒(CD+TI)、髓芯减压+人工骨(CD+SBS)、髓芯减压+骨髓间充质干细胞(CD+BMSC)和髓芯减压+富血小板血浆(CD+PRP)方面分析当前各种方法的优势和不足,并对基于髓芯减压的保髋治疗策略进行展望,希望能为ONFH治疗决策提供参考。

Treatment of osteonecrosis of the femoral head(ONFH)continues to be a scientific challenge.Early ONFH treatment was aimed at alleviating symptoms,improving hip function,delaying its progression and preventing the collapse of the femoral head.Core decompression-based strategies may be effective solutions of joint preservation for early ONFH.Over the past decades,core decompression-based strategies have shown encouraging outcomes,but they are still controversial.The article reviews the latest research progresses,analyzes the advantages and disadvantages of core decompression(CD),multiple drilling,CD+non-vascularized bone-grafting,CD+vascularized bone-grafting,CD+tantalum implants,CD+synthetic bone substitutes,CD+bone mesenchymal stem cell and CD+platelet-rich plasma,and gives some future perspectives for the treatment of ONFH,so as to provide references for clinical decision-making.