中国成人股骨头坏死临床诊疗指南(2020)

Chinese guidelines for clinical diagnosis and treatment of osteonecrosis of the femoral head in adults(2020)

股骨头坏死(osteonecrosis of the femoral head,ONFH)是临床常见的难治性疾病。虽然其确切的病理生理机制尚不完全清楚,但普遍认为与骨内循环中断和最终骨组织死亡紧密相关。股骨头坏死的预防和保头治疗一直是临床骨科医生面临的巨大挑战。为进一步规范ONFH的诊断和治疗,2020版指南在"中国成人股骨头坏死诊疗指南(2016)"的基础上,对ONFH的流行病学、病因学、病理生理学、影像学、诊断和治疗的新进展等方面进行了修订和更新。国际骨循环研究学会(The Association Research Circulation Osseous,ARCO)制订的股骨头坏死分期在指导治疗、判断预后、评估疗效等方面广泛应用,最新的ARCO分期系统(2019版)也引入指南中。指南不仅建立了ONFH的基本诊断、治疗和评价体系,还提供了流行病学、病因学、诊断标准、病理分期、预防和治疗选择(包括中医药治疗)以及术后康复等方面的专家意见和标准。根据不同阶段骨坏死的骨内血供变化,推荐相应的非手术治疗和手术治疗;存在ONFH的可能危险因素时,建议采取一定的预防措施以避免股骨头坏死的发生。指南为骨坏死提供了简要的分类标准和治疗方案。明确病因、综合考虑不同阶段股骨头坏死的血运状态、髋关节功能、患者的年龄和职业是诊断和制定治疗策略的重要步骤。

Osteonecrosis of the femoral head(ONFH)is a common and refractory disease.Although it is thought to be associated with circulatory disruption and resultant bone death,its exact pathophysiologic mechanism is not fully understood.Prevention and treatment of ONFH has always been a clinical challenge for orthopedic surgeons.To further standardize diagnosis and treatment of ONFH,the present clinical practice guideline(2020 version)was updated based on"Chinese guideline for the diagnosis and treatment of osteonecrosis of the femoral head in adults(2016)".The classification system established by the Association Research Circulation Osseous(ARCO)had been widely used in guiding treatment,estimating prognosis,and evaluating efficacy.The ARCO staging system(2019 version)was also introduced in the present guideline.Based on the changes in the intraosseous blood supply at different stages,the corresponding nonsurgical and surgical treatments were recommended.For patients with risk factors for potential ONFH,preventive interventions to avoid the occurrence of osteonecrosis were recommended.New advances in the epidemiology,etiology,pathophysiology,imaging,diagnosis and treatment of ONFH were renewed in this 2020 version guideline.The guideline not only provided primary diagnosis,treatment and evaluation systems for ONFH,but also added some expert advices and consensus,including epidemiology,etiology,diagnostic criteria,pathological staging,prevention,Chinese traditional medicine treatment and postoperative rehabilitation.The guideline provided brief classification criteria and treatment regimen for ONFH.The guideline emphasized the important steps in diagnosis and developing treatment strategies,including specification of the etiology,treatment plan based on comprehensive consideration of the changes in the intraosseous blood supply at different stages of ONFH,hip function,age and occupation of the patients.