Hungerford David S
Johns Hopkins Orthopedics at Good Samaritan Hospital, Johns Hopkins University, Baltimore, Maryland, USA.
J Arthroplasty. 2007 Jun;22(4 Suppl 1):91-4. doi: 10.1016/j.arth.2007.02.009.
Since the 1970s, the mantra of those treating osteonecrosis of the femoral head was to save the head at all costs. Total hip arthroplasty (THA), the only effective surgical treatment once the head has mechanically and clinically failed, had a poor track record for young active patients. Recently, THA using highly cross-linked polyethylene, metal-on-metal bearing surfaces, or ceramic-on-ceramic bearing surfaces have given promising results, changing the "save-at-all-costs" paradigm. Operations that have a low success rate, high complication rate or morbidity, or compromise subsequent THA can no longer be justified. This includes femoral osteotomy and free vascularized fibular graft. Core decompression is justified, when indicated, because of its low morbidity and absence of complications with subsequent THA.
自20世纪70年代以来，治疗股骨头坏死的理念是不惜一切代价保住股骨头。全髋关节置换术（THA）是股骨头在机械和临床方面出现问题后唯一有效的手术治疗方法，但对于年轻活跃的患者来说，其治疗效果不佳。最近，使用高度交联聚乙烯、金属对金属承重表面或陶瓷对陶瓷承重表面的THA取得了令人鼓舞的结果，改变了“不惜一切代价挽救”的模式。成功率低、并发症发生率或发病率高，或影响后续THA的手术已不再合理。这包括股骨截骨术和游离带血管腓骨移植术。在有指征时，髓芯减压术是合理的，因为其发病率低，且后续THA无并发症。
