股骨头坏死早期保髋手术的选择与疗效评定

Selection and efficacy evaluation of hip preservation surgery for early osteonecrosis of the femoral head

股骨头坏死(ONFH)是我国高发的骨科疾病,也是我国人工全髋关节置换术(THA)的第一大病因。ONFH早期的治疗方法很多,包括保守治疗和手术治疗2种,但不同治疗方式的长期临床效果,文献报道不一。ONFH的治疗受患者和医师对这种疾病认知等多种因素的影响。保髋手术的原理主要包括ONFH区域减压、清除坏死区域坏死骨、坏死区域植骨、软骨下骨提供结构性骨支撑、带血管的骨移植、粗隆间截骨术等。ONFH疗效评定常采用3种评价方法,包括临床效果评估系统、影像学评估、以最终临床结果评定。目前认为ONFH各种保守治疗临床效果证据等级可疑,各种保髋手术方法证据等级也存在差异性。采用经大粗隆的入路减压植骨加结构性骨支撑治疗早期ONFH,具有手术微创损伤小、可重复性强、可操作性强、手术技术容易掌握,临床效果肯定尤其是长期疗效等方面都具明显的优势。

Osteonecrosis of the femoral head(ONFH)is a common orthopedic disease in China,and it is also the first major cause of total hip arthroplasty(THA)in China.There are many early treatment methods for ONFH,including conservative treatment and surgical treatment,but the long-term clinical effects of different treatment modalities have not been reported in the literature.The treatment of ONFH has been influenced by many factors such as patients′and physicians′perception of the disease.The principles of hip preservation surgery mainly include ONFH decompression,removal of necrotic bone,bone grafting in necrotic area,structural bone support of subchondral bone,vascular bone transplantation,intertrochanteric osteotomy,etc.There are three evaluation methods for ONFH efficacy evaluation,including clinical effect evaluation system,imaging evaluation,and final clinical outcome evaluation.At present,it is considered that the grade of evidence for clinical effect of various conservative treatment of ONFH is doubtful,and the grade of evidence of various hip preservation surgery methods is also different.In the treatment of early ONFH,the approach of decompression and bone grafting via greater trochanter plus structural bone support has obvious advantages in terms of minimal invasive surgery,strong repeatability,operability,easy to master surgical techniques,positive clinical effects,especially long-term effects.