Maus U, Flechtenmacher J, Peters K M
Universitätsklinik für Orthopädie und Unfallchirurgie, Pius-Hospital Oldenburg, Georgstraße 12, 26121, Oldenburg, Deutschland.
Orthopädische Gemeinschaftspraxis am Ludwigsplatz, Waldstraße 67, 76133, Karlsruhe, Deutschland.
Orthopade. 2018 Sep;47(9):735-744. doi: 10.1007/s00132-018-3616-6.
Femoral head necrosis is a progressive disease that can progress within a relatively short time. Therefore, an early and clear diagnosis including stage classification and treatment is necessary to prevent or delay the onset of the femoral head and joint destruction.
In addition to the identification of possible risk factors and treatment, the question of the available treatment options arises. The present article deals with conservative treatment options and presents the published results in the sense of the currently available evidence and against the background of the S3 guideline on atraumatic femoral head necrosis. The results of physical therapy, drug therapy (iloprost and bisphosphonates ), electrotherapy, shockwave therapy, etc. are presented. In the early stages of femoral head necrosis with low expansion, alendronate gives positive results. Iloprost is also a successful conservative treatment option in the early stages of atraumatic femoral head necrosis (ARCO I and II). In stages ARCO III and IV, Ilomedin is no longer indicated. Anticoagulants, such as enoxaparin, have demonstrated an arthroprotective effect.
股骨头坏死是一种进展性疾病，可在相对较短的时间内发展。因此，为预防或延缓股骨头和关节破坏的发生，进行包括分期分类和治疗在内的早期明确诊断很有必要。
除了识别可能的风险因素和进行治疗外，还会出现可用治疗方案的问题。本文探讨保守治疗方案，并根据当前可得证据以及非创伤性股骨头坏死S3指南的背景，展示已发表的结果。介绍了物理治疗、药物治疗（伊洛前列素和双膦酸盐）、电疗、冲击波治疗等的结果。在股骨头坏死早期且扩展程度较低时，阿仑膦酸钠有积极效果。伊洛前列素在非创伤性股骨头坏死（ARCO I和II期）早期也是一种成功的保守治疗选择。在ARCO III和IV期，不再推荐使用伊洛前列素。抗凝剂，如依诺肝素，已显示出关节保护作用。
