New England Musculoskeletal Institute, Department of Orthopaedic Surgery, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA.
Clin Orthop Relat Res. 2012 Feb;470(2):525-34. doi: 10.1007/s11999-011-2050-4.
Although surgeons use many procedures to preserve the femoral head in patients with hip osteonecrosis, there is no consensus regarding the best procedure.
QUESTIONS/PURPOSES: We raised the following questions: (1) Is one surgical treatment preferred based on published data? (2) What are the rates of radiographic progression or conversion to THA after treatment of pre- and postcollapse hips? (3) Does lesion size in the femoral head influence progression? And (4) does the extent of involvement of the weightbearing surface of the femoral head influence outcome?
We searched MEDLINE and Scopus for articles published between 1998 and 2010. We included only articles assessing an operative intervention for hip osteonecrosis and having a level of evidence of I to IV. We included 54 of the 488 reviewed manuscripts.
No procedure was superior to others. In pre- and postcollapse hips, 264 of 864 hips (31%) and 419 of 850 hips (49%), respectively, exhibited radiographic disease progression. There were lower failure rates when the lesion involved less than 15% of the femoral head or had a necrotic angle of less than 200° (14%-25%) and when the osteonecrotic lesion involved only the medial 1/3 of the weightbearing surface (4.6%).
The best treatment of precollapse lesions is difficult to determine due to the limitations of the available literature. However, the data suggest operative intervention prevents collapse of small lesions of the femoral head or when there is a limited amount of the weightbearing surface involved. Patients with head collapse have a high progression rate after a femoral head-saving procedure.
尽管外科医生在治疗股骨头坏死患者时会采用多种方法来保留股骨头，但哪种方法最好仍没有共识。
问题/目的：我们提出了以下问题：（1）根据已发表的数据，是否有一种手术治疗方法更受青睐？（2）治疗股骨头未塌陷和塌陷前期及后期的髋关节后，影像学进展或转为全髋关节置换术的发生率是多少？（3）股骨头内病变大小是否会影响进展？（4）股骨头负重面受累的程度是否会影响结果？
我们在 MEDLINE 和 Scopus 上检索了 1998 年至 2010 年期间发表的文章。我们仅纳入评估股骨头坏死手术干预并具有 I 级至 IV 级证据的文章。共纳入 488 篇综述文章中的 54 篇。
没有一种方法优于其他方法。在股骨头未塌陷和塌陷前期及后期的髋关节中，分别有 864 个髋关节中的 264 个（31%）和 850 个髋关节中的 419 个（49%）出现影像学疾病进展。当病变累及股骨头小于 15%或坏死角度小于 200°（14%-25%），或股骨头坏死病变仅累及负重面的内侧 1/3（4.6%）时，失败率较低。
由于现有文献的局限性，难以确定早期股骨头塌陷病变的最佳治疗方法。然而，数据表明，手术干预可以预防小股骨头病变的塌陷，或当负重面受累的量有限时。行保头手术的股骨头塌陷患者进展率较高。
