骨科是贯彻实施快速康复外科(enhanced recovery after surgery,ERAS)理念及措施的主要专业之一。我国自2012年开始将ERAS理念及措施应用骨科关节置换术领域,在包括骨科、麻醉科、内科、营养科、精神科等多学科合作下,不断研究、探索、...骨科是贯彻实施快速康复外科(enhanced recovery after surgery,ERAS)理念及措施的主要专业之一。我国自2012年开始将ERAS理念及措施应用骨科关节置换术领域,在包括骨科、麻醉科、内科、营养科、精神科等多学科合作下,不断研究、探索、完善、优化ERAS理念及措施,使我国骨科、特别是关节外科得到极大的发展。在不断探索、优化ERAS理念、措施基础上,在国家卫生健康委员会加速康复外科专家委员会骨科专家组的共同协作下,先后推出《骨科加速康复围手术期疼痛管理专家共识》等8个专家共识,涵盖了疼痛管理、血液管理、麻醉管理等各个领域。同时,我国政府相关部门也认识到ERAS理念及措施在促进我国医疗卫生事业、规范相关医疗程序的重要性。相继推出了相关的规范、共识,以引导ERAS在我国科学、规范、良性发展,2019年11月15日发布“国家卫生健康委办公厅关于开展加速康外科试点工作的通知”。基于循证医学证据基础上的ERAS理念以及相关措施的实施,极大地促进了ERAS理念、措施在我国的科学实施,极大地促进了现代医学的发展。展开更多
Objective To review the recent developments in the mechanisms of glucocorticoids induced osteonecrosis of femoral head （ONFH） and introduce a new theory of ONFH.Data sources Both Chinese- and English-language litera...Objective To review the recent developments in the mechanisms of glucocorticoids induced osteonecrosis of femoral head （ONFH） and introduce a new theory of ONFH.Data sources Both Chinese- and English-language literatures were searched using MEDLINE （1997-2011）,Pubmed （1997-2011 ） and the Index of Chinese-language Literature （1997-2011 ）.Study selection Data from published articles about mechanisms of glucocorticoids induced ONFH in recent domestic and foreign literature were selected.Data extraction Data were mainly extracted from 61 articles which are listed in the reference section of this review.Results Glucocorticoids are steroid hormones secreted by the adrenal cortex that play a pivotal role in the regulation of a variety of developmental,metabolic and immune functions.However,high dose of exogenous glucocorticoids usage is the most common non-traumatic cause of ON FH.Glucocorticoids can affect the metabolisms of osteoblasts,osteoclasts,bone marrow stromal cells and adipocytes which decrease osteoblasts formation but increase adipocytes formation and cause ONFH finally.Conclusions Glucocorticoids affect the differentiation of mesenchymal stem cells,through activating or inhibiting the related transcript regulators of osteogenesis and adipogenesis.At last,the size and volume of mesenchymal stem cells derived adipocytes will increase amazingly,but the osteoblasts will be decreased obviously.In the meantime,the activity of the osteoclasts will be activated.So,these mechanisms work together and lead to ONFH.展开更多
文摘骨科是贯彻实施快速康复外科(enhanced recovery after surgery,ERAS)理念及措施的主要专业之一。我国自2012年开始将ERAS理念及措施应用骨科关节置换术领域,在包括骨科、麻醉科、内科、营养科、精神科等多学科合作下,不断研究、探索、完善、优化ERAS理念及措施,使我国骨科、特别是关节外科得到极大的发展。在不断探索、优化ERAS理念、措施基础上,在国家卫生健康委员会加速康复外科专家委员会骨科专家组的共同协作下,先后推出《骨科加速康复围手术期疼痛管理专家共识》等8个专家共识,涵盖了疼痛管理、血液管理、麻醉管理等各个领域。同时,我国政府相关部门也认识到ERAS理念及措施在促进我国医疗卫生事业、规范相关医疗程序的重要性。相继推出了相关的规范、共识,以引导ERAS在我国科学、规范、良性发展,2019年11月15日发布“国家卫生健康委办公厅关于开展加速康外科试点工作的通知”。基于循证医学证据基础上的ERAS理念以及相关措施的实施,极大地促进了ERAS理念、措施在我国的科学实施,极大地促进了现代医学的发展。
文摘Objective To review the recent developments in the mechanisms of glucocorticoids induced osteonecrosis of femoral head （ONFH） and introduce a new theory of ONFH.Data sources Both Chinese- and English-language literatures were searched using MEDLINE （1997-2011）,Pubmed （1997-2011 ） and the Index of Chinese-language Literature （1997-2011 ）.Study selection Data from published articles about mechanisms of glucocorticoids induced ONFH in recent domestic and foreign literature were selected.Data extraction Data were mainly extracted from 61 articles which are listed in the reference section of this review.Results Glucocorticoids are steroid hormones secreted by the adrenal cortex that play a pivotal role in the regulation of a variety of developmental,metabolic and immune functions.However,high dose of exogenous glucocorticoids usage is the most common non-traumatic cause of ON FH.Glucocorticoids can affect the metabolisms of osteoblasts,osteoclasts,bone marrow stromal cells and adipocytes which decrease osteoblasts formation but increase adipocytes formation and cause ONFH finally.Conclusions Glucocorticoids affect the differentiation of mesenchymal stem cells,through activating or inhibiting the related transcript regulators of osteogenesis and adipogenesis.At last,the size and volume of mesenchymal stem cells derived adipocytes will increase amazingly,but the osteoblasts will be decreased obviously.In the meantime,the activity of the osteoclasts will be activated.So,these mechanisms work together and lead to ONFH.
