Petje Gert, Radler Christof, Aigner Nicolas, Manner Hannes, Kriegs-Au Gabriele, Grill Franz
Orthopaedic Hospital Vienna - Speising, Department of Pediatric Orthopaedics, Speisinger Strasse 109, 1134 Vienna, Austria.
Expert Opin Pharmacother. 2004 Jul;5(7):1455-62. doi: 10.1517/14656566.5.7.1455.
Aseptic osteonecrosis (AON) in children can progress during ossification of cartilage in periods of increased growth or excessive physical stain and may occur in various locations in the skeleton. Disturbance of blood supply to the bone has been suggested as the main pathological mechanism involved in AON, which is characterised by the death of bone marrow and trabecular bone. The extent and development of osteonecrosis and the duration of disease until restorative healing, depend on the formation of new blood vessels, the spreading of vessels in the affected bony areas, the absorption of osteonecrotic tissue and the structure of new bone. Conservative and operative treatment options for AON vary according to the location and development of the disease and the age of the patient. The goal of all treatment options currently used today is to achieve relief of physical load in the affected bone and to promote and regulate blood supply. Treatment should be started early in order to minimise the extent of osteonecrosis and allow restorative healing. As the processes of myelopoiesis, myelophthisis and fracture healing become more clear, interest has focused on advances in the utilisation of bioactive factors to salvage bone in children affected by AON. Such methods include the use of osteoinductive agents, such as cytokines and bone morphogenetic proteins, as well as factors that stimulate angiogenesis and regulate blood supply. Currently, the prostacyclin analogue, iloprost (Ilomedin, Schering AG), has been successfully used in a pilot study in children suffering from early stages of AON.
儿童无菌性骨坏死（AON）在生长加速期或过度体力负荷时，可在软骨骨化过程中进展，且可发生于骨骼的不同部位。骨血供紊乱被认为是AON的主要病理机制，其特征为骨髓和小梁骨死亡。骨坏死的范围和发展以及疾病直至修复愈合的持续时间，取决于新血管的形成、血管在受累骨区域的蔓延、骨坏死组织的吸收以及新骨的结构。AON的保守和手术治疗方案因疾病的部位和发展以及患者年龄而异。目前所有治疗方案的目标都是减轻受累骨的物理负荷，并促进和调节血供。治疗应尽早开始，以尽量减少骨坏死的范围并实现修复愈合。随着骨髓生成、骨髓消耗和骨折愈合过程变得更加清晰，人们的兴趣集中在利用生物活性因子挽救受AON影响儿童骨骼方面的进展。此类方法包括使用骨诱导剂，如细胞因子和骨形态发生蛋白，以及刺激血管生成和调节血供的因子。目前，前列环素类似物伊洛前列素（Ilomedin，先灵公司）已在AON早期儿童的一项试点研究中成功应用。
