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髓芯减压术治疗早中期股骨头缺血坏死研究进展
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Abstract:
股骨头坏死(Osteonecrosis of the Femoral Head, ONFH)是骨科常见且难治的骨坏死性疾病，关于其病因的研究，目前仍没有一种病理生理机制能够完全解释ONFH的病因。ONFH进展快，预后差，有文献报道其5年塌陷率达到70%，是青壮年致残的主要病因之一。有10%的人工全髋关节置换(Total Hip Arthroplasty, THA)也是由于ONFH导致的。因此预防股骨头塌陷成为治疗ONFH中的关键。髓芯减压术(core decompression, CD)是一种理论上降低股骨头骨内压的技术，促进局部血供恢复。其功效已被证明可延缓早期软骨下塌陷。本文通过介绍近年来国内外学者对髓芯减压治疗ONFH的各种方式及成果进行综述。
Osteonecrosis of the Femoral Head (ONFH) is a common and refractory osteonecrosis disease in or-thopedics. There is still no pathophysiological mechanism that can fully explain the etiology of ONFH. ONFH progresses rapidly and has a poor prognosis. It has been reported that the 5-year collapse rate of ONFH is up to 70%, which is one of the main causes of disability in young adults. ONFH is also responsible for 10% of Total hip arthroplasty (THA). Therefore, prevention of femoral head collapse becomes the key to the treatment of ONFH. Core decompression (CD) is a technique that theoreti-cally reduces intra-osseous pressure of the femoral head and promotes restoration of local blood supply. Its efficacy has been shown to delay early subchondral collapse. This article reviews the methods and results of core decompression in the treatment of ONFH by domestic and foreign scholars in recent years.
| [1] | Mont, M.A. and Hungerford, D.S. (1995) Non-Traumatic Avascular Necrosis of the Femoral Head. The Journal of Bone and Joint Surgery, 77, 459-474. https://doi.org/10.2106/00004623-199503000-00018 |
| [2] | Gangji, V., Hauzeur, J.P., Schoutens, A., Hinsenkamp, M., et al. (2003) Abnormalities in the Replicative Capacity of Osteoblastic Cells in the Proximal Femur of Patients with Osteonecrosis of the Femoral Head. The Journal of Rheumatology, 30, 348-351. |
| [3] | Rocchi, M., Del, P.N., Mazzotta, A., et al. (2020) Core Decomression with Bone Chips Allograft in Combination with Fibrin Platelet-Rich Plasma and Concentrated Autologous Mesenchymal Stromal Cells, Isolated from Bone Marrow: Results for the Treatment of Avascular Necrosis of the Femoral Head after 2 Years Minimum Follow-Up. HIP International, 30, 2385-2386. https://doi.org/10.1177/1120700020964996 |
| [4] | 余振阳, 蔡谞, 谷旺. 改良多孔道髓芯减压术与传统钻孔减压术治疗早期股骨头缺血坏死的疗效观察[J]. 解放军医学院学报, 2016, 37(11): 1148-1151. |
| [5] | 杨静, 康鹏德, 沈彬, 等. 小孔径多通道髓芯钻孔减压治疗早中期股骨头坏死[J]. 中华骨科杂志, 2010, 30(1): 58-61. |
| [6] | 张国梁, 包毅敏, 刘瑞, 等. 蜂巢式髓芯减压术治疗早中期成人股骨头缺血性坏死的疗效观察[J]. 生物骨科材料与临床研究, 2016, 13(1): 13-16+20. |
| [7] | 任政, 刘修信, 沈志敏. 改良多孔髓芯减压修复早期股骨头缺血性坏死: 髋关节置换率5年随访[J]. 中国组织工程研究, 2014, 18(53): 8529-8535. |
| [8] | 张晨, 张二洋, 李苗, 等. 髓芯减压联合纳米骨植入治疗早期股骨头坏死的近期疗效[J]. 山西医科大学学报, 2016, 47(6): 565-569. |
| [9] | 刘德淮, 陈前芬, 陈源, 等. 髓芯减压植骨术治疗早、中期股骨头缺血性坏死的远期疗效[J]. 中国修复重建外科杂志, 2012, 26(10): 1165-1168. |
| [10] | 孙哲, 张宏军, 范克杰, 等. 髓芯减压打压植骨腓骨支撑术联合股骨头坏死愈胶囊治疗早中期股骨头坏死疗效分析[J]. 亚太传统医药, 2017, 13(2): 127-129. |
| [11] | Kin, S.Y., Kin, Y.G., Kin, P.T., et al. (2005) Vascularized Compared with Non-Vascularized Fibular Grafts for Largeoste-onecrotic Lesions of the Femoral Head. The Journal of Bone and Joint Surgery, 87, 2012-2018.
https://doi.org/10.2106/00004623-200509000-00015 |
| [12] | Mont, M.A., Etienne, G. and Ragland, P.S. (2003) Out-come of Nonvascularized Bone Grafting for Osteonecrosis of the Femoral Head. Clinical Orthopaedics and Related Re-search, No. 417, 84-92.
https://doi.org/10.1097/01.blo.0000096826.67494.38 |
| [13] | 苏敬阳, 张耀杰, 曹斌, 等. 多孔钽棒治疗ARCO I-II期非创伤性股骨头坏死后塌陷及相关因素分析[J]. 中国组织工程研究, 2021, 25(15): 2400-2404. |
| [14] | 毛小成, 赵枫. 髓心减压金属钽棒植入治疗早期股骨头坏死[J]. 临床军医杂志, 2012, 40(6): 1525-1527. |
| [15] | 叶福生, 倪哲吉, 储小兵, 等. 钽棒置入治疗早期股骨头坏死近期疗效分析[J]. 中国骨伤, 2013, 26(8): 646-650. |
| [16] | Floerkemeier, T., Lutz, A., Nackenhorst, U., et al. (2011) Core Decompression and Osteonecrosis Inter-vention Rod in Osteonecrosis of the Femoral Head: Clinical Outcome and Finite Element Analysis. International Ortho-paedics, 35, 1461-1466. https://doi.org/10.1007/s00264-010-1138-x |
| [17] | Pakos, E.E., Megas, P., Paschos, N.K., et al. (2015) Modified Porous Tantalum Rod Technique for the Treatment of Femoral Head Osteonecrosis. World Journal of Orthopedics, 6, 829-837. https://doi.org/10.5312/wjo.v6.i10.829 |
| [18] | 石晶晟, 夏军, 魏亦兵, 等. 多孔钽金属棒治疗股骨头坏死的短期临床疗效[J]. 中华关节外科杂志(电子版), 2012, 6(1): 65-70. |
| [19] | 王帅, 张宏军, 张延召, 等 . 细针多孔道钻孔减压术联合体外冲击波治疗早期股骨头坏死疗效观察[J]. 风湿病与关节炎, 2015, 4(1): 41-43. |
| [20] | 杨建平, 王黎明. 多孔髓芯减压联合干细胞移植治疗股骨头坏死的早期随访结果[J]. 中国组织工程研究与临床康复, 2007, 20(2): 3936-3939. |
| [21] | Hernigou, P., Dubory, A., Homma, Y., et al. (2018) Cell Therapy versus Simultaneous Contralateral Decompression in Symptomatic Corticosteroid Osteonecrosis: A Thirty Year Fol-low-Up Prospective Randomized Study of One Hundred and Twenty Five Adult Patients. International Orthopaedics, 42, 1639-1649.
https://doi.org/10.1007/s00264-018-3941-8 |
