Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M.A. Mont:
Mayo Clinic, 200 First Street S.W., Gonda 14 South, Rochester, MN 55905.
J Bone Joint Surg Am. 2015 Oct 7;97(19):1604-27. doi: 10.2106/JBJS.O.00071.
➤ Although multiple theories have been proposed, no one pathophysiologic mechanism has been identified as the etiology for the development of osteonecrosis of the femoral head. However, the basic mechanism involves impaired circulation to a specific area that ultimately becomes necrotic.➤ A variety of nonoperative treatment regimens have been evaluated for the treatment of precollapse disease, with varying success. Prospective, multicenter, randomized trials are needed to evaluate the efficacy of these regimens in altering the natural history of the disease.➤ Joint-preserving procedures are indicated in the treatment of precollapse disease, with several studies showing successful outcomes at mid-term and long-term follow-up.➤ Studies of total joint arthroplasty, once femoral head collapse is present, have described excellent outcomes at greater than ten years of follow-up, which is a major advance and has led to a paradigm shift in treating these patients.➤ The results of hemiresurfacing and total resurfacing arthroplasty have been suboptimal, and these procedures have restricted indications in patients with osteonecrosis of the femoral head.
➤ 尽管已经提出了多种理论，但尚未确定股骨头坏死发展的病因的病理生理机制。然而，基本机制涉及到特定区域的循环受损，最终导致坏死。➤ 已经评估了多种非手术治疗方案来治疗塌陷前疾病，成功率各不相同。需要进行前瞻性、多中心、随机试验来评估这些方案在改变疾病自然史方面的疗效。➤ 在塌陷前疾病的治疗中，关节保存手术是指征，多项研究表明在中期和长期随访中取得了成功的结果。➤ 一旦出现股骨头塌陷，对全髋关节置换术的研究描述了超过十年随访的出色结果，这是一个重大进展，导致了治疗这些患者的范式转变。➤ 半髋关节置换术和全髋关节表面置换术的结果并不理想，这些手术在股骨头坏死患者中的适应证受到限制。
