基于“态靶结合”理论探讨围塌陷期股骨头坏死精准保髋

Accurate Hip Preservation of ONFH during Peri-collapse Based on "State-target Combination" Theory

股骨头缺血性坏死(osteonecrosis of femoral head, ONFH)是骨科难治性疾病之一,以中青年居多;保留自身髋关节往往是患者的第一需求;但由于保髋适应症与手术时机选择不同,手术技术的差异,导致各种保髋术式疗效不一。何伟教授基于大量ONFH保髋经验及研究成果,提出了ONFH“围塌陷期”理论,认为围塌陷期是ONFH保髋的最佳时期,及时精确诊断是保髋成功的关键。仝小林院士“态靶结合”临床辨治方略是借鉴现代医学审视并厘清疾病发展各阶段的核心病机,观注疾病“因态”和“果态”,是中医传统模式与现代科技结合的临床辨证新模式。基于“态靶结合”理论,提出在ONFH治疗过程中,应“以病为纬”,充分认识“血瘀证贯穿ONFH的始终”,血瘀证为ONFH疾病之“态”,并将活血通络法贯穿于ONFH全疾病周期治疗始终。同时提出ONFH修复过程中生物力学变化而导致的股骨头塌陷为ONFH围塌陷期之“态”,X光与CT显示的股骨头前外侧柱状态、MRI显示的软骨下骨状态为ONFH保髋之“靶”,围塌陷期ONFH的保髋治疗方式选择应注意“态靶结合”,根据不同的病理状态选择相应的保髋方式,精确诊断、精准打靶,有效恢复ONFH的前外侧柱并为软骨下骨修复提供条件,是保髋手术成功的前提。

Osteonecrosis of femoral head(ONFH)is one of the refractory diseases in orthopedics.Most of the patients are young and middle-aged.Preserving their own hip joint is often the most urgent desire of patients.However,due to the different indications and timing of surgery,the difference in surgical techniques has led to different results reported in the literature of hip-preserving surgery.Based on a large number of hip-preserving experiences and research results of ONFH,Professor HE Wei proposed the"peri-collapse period"theory of osteonecrosis of femoral head.He believes that the peri-collapse period is the best period for ONFH hip preservation,and timely and accurate diagnosis is the key to the success of hip preservation.Academician TONG Xiaolin’s"combination of state and target"clinical defense strategy is to use modern medicine to examine and clarify the core pathogenesis of each stage of disease development,and pay attention to the"cause state"and"effect state"of diseases is a new clinical syndrome differentiation mode combining traditional Chinese medicine with modern science and technology.Based on the theory of"state-target combination",this article proposes that in the treatment of ONFH,the disease should be regarded as the latitude,and it is fully understood that"blood stasis syndrome runs through ONFH"and blood stasis syndrome is the"state"of the disease.And activating blood and dredging collaterals method is used throughout the whole disease cycle of ONFH.At the same time,it is proposed that the collapse of the femoral head caused by the biomechanical changes during the repair of ONFH is the"state"of the collapse period of ONFH.The shape of the anterior lateral column of the femoral head detected by X-ray and CT,and the shape of the subchondral bone shown by MRI are the"targets"for hip-preserving treatment of ONFH.When choosing hip-preserving treatment for ONFH during peri-collapse,the attention should be paid to"state-target combination",and the corresponding hip-preserving methods should be selected according to different pathological conditions.Precise diagnosis,precise shooting and effective restoration of the anterolateral column of ONFH and provision of conditions for subchondral bone repair are the prerequisites for the success of hip preservation surgery.