Lafforgue Pierre
Service de Rhumatologie Sud, CHU La Conception, 13385 Marseille Cedex 5.
Rev Prat. 2006 Apr 30;56(8):817-25.
Avascular necrosis (AVN) most commonly affects the femoral head, but not exclusively. Besides post-traumatic avascular necrosis of the femoral head, other sites should also be screened, especially the other hip, the shoulders and the knees. AVN of the femoral head should systematically be considered in anyone suffering from hip pain with normal X-ray. The most useful complementary examinations are standard X-ray examination, to assess the stage of disease progression, and MRI, to establish the diagnosis when X-ray shows no abnormality and assess the prognosis. The spontaneous progression mainly depends on the lesion size and the amount of affected weight-bearing surface. Differentiating AVN from algodystrophy and especially stress fracture of the femoral head may be difficult, even with MRI. An etiology may be found in approximately _ of the cases. Medical treatment still exclusively addresses symptoms. Surgical treatment essentially consists of core decompression of the femoral head, the efficiency of which is still debated, and total hip arthroplasty, but new therapeutic options are likely to be developed. Above all, indications depend on the age, the stage of disease progression (prior to or following the subchondral fracture) and prognosis (lesion size and site on the MRI).
缺血性坏死（AVN）最常累及股骨头，但并非仅限于此。除了创伤后股骨头缺血性坏死外，其他部位也应进行筛查，尤其是另一侧髋关节、肩部和膝盖。对于任何X线正常但患有髋部疼痛的患者，都应系统地考虑股骨头缺血性坏死。最有用的辅助检查是标准X线检查，以评估疾病进展阶段；以及MRI，当X线无异常时用于确诊，并评估预后。自发进展主要取决于病变大小和受影响的负重面面积。即使使用MRI，将缺血性坏死与痛性营养不良尤其是股骨头应力性骨折区分开来也可能很困难。约_的病例可找到病因。药物治疗仍仅针对症状。手术治疗主要包括股骨头髓芯减压术（其疗效仍存在争议）和全髋关节置换术，但可能会开发新的治疗选择。最重要的是，手术指征取决于年龄、疾病进展阶段（软骨下骨折之前或之后）和预后（MRI上的病变大小和部位）。
