Hungerford D S
Johns Hopkins University, School of Medicine, Baltimore, Maryland.
Orthopade. 1990 Aug;19(4):219-23.
Nontraumatic ischemic necrosis of the femoral head remains a source of much controversy. The etiology is also controversial. Possibilities are: hypertrophy of intraosseous structures (lipocytes, hematopoietic elements), creating intraosseous hypertension; alcohol and steroids as toxic agents; circulating fat globules embolizing the microcirculation of the metaphysis. The disease appears most frequently in young adults, but no satisfactory nonoperative treatment modalities have been reported as yet. In 1971, Ficat and Arlet published their results on core decompression performed in 100 patients, with a follow-up of from 1 to 5 years. The results for those with stage I disease (n = 40) were good or excellent in 88% of the patients. The results for those with stage II disease (n = 16) were good or excellent in 69%. Based on current experience, the treatment is to be recommended for patients with pre-collapse stages 0, I and IIA of ischemic necrosis of the femoral head. For stage III disease, the procedure may reduce pain at night and at rest and can be considered in patients wishing to avoid total hip arthroplasty for a period of time.
非创伤性股骨头缺血性坏死仍然是一个充满诸多争议的问题。其病因也存在争议。可能的病因有：骨内结构（脂肪细胞、造血成分）肥大，导致骨内高压；酒精和类固醇作为毒性物质；循环中的脂肪球栓塞干骺端微循环。该病最常出现在年轻人中，但目前尚未有令人满意的非手术治疗方法报道。1971年，菲卡特和阿莱发表了他们对100例患者进行髓芯减压的结果，随访时间为1至5年。I期疾病患者（n = 40）中，88%的患者结果为良好或优秀。II期疾病患者（n = 16）中，69%的患者结果为良好或优秀。根据目前的经验，对于股骨头缺血性坏死0期、I期和IIA期塌陷前的患者，推荐采用这种治疗方法。对于III期疾病，该手术可能会减轻夜间和休息时的疼痛，对于希望在一段时间内避免全髋关节置换术的患者可以考虑采用。
