Pijnenburg L, Felten R, Javier R-M
Service de rhumatologie, centre de compétence des maladies osseuses rares, hôpitaux universitaires de Strasbourg, université de Strasbourg, 67000 Strasbourg, France.
Service de rhumatologie, centre de compétence des maladies osseuses rares, hôpitaux universitaires de Strasbourg, université de Strasbourg, 67000 Strasbourg, France.
Rev Med Interne. 2020 Jan;41(1):27-36. doi: 10.1016/j.revmed.2019.10.332. Epub 2019 Nov 10.
Avascular necrosis is an ischemic or cytotoxic necrosis of epiphyseal bone, responsible for joint pain, altered life quality and frequently affecting young patients. Avascular necrosis can be unifocal or multifocal, underlining the possibility of a systemic origin. Avascular necrosis involves the femoral head in more than 75% of cases. Although avascular necrosis is irreversible, many risk factors must be sought, including corticosteroid treatment, hypercholesterolemia, sickle cell disease or alcohol abuse. MRI imaging is the main exploration for the diagnostic and staging of the disease, and should be performed in unexplained hip pain in young patients with normal X-rays. In the earlier stages of the disease (stage I and II of the Arlet and Ficat classification), joint surface is preserved, and conservative treatment is recommended. In the more advanced stages (III and IV of the Arlet and Ficat classification), the articular surface collapses and joint arthroplasty is the main treatment. However, there are some recent therapeutic advances, based on mesenchymal stem cells, which may contribute, in the future, to improve the bad functional prognosis of the disease.
缺血性坏死是骨骺骨的缺血性或细胞毒性坏死，可导致关节疼痛、生活质量下降，且常影响年轻患者。缺血性坏死可为单灶性或多灶性，提示可能存在全身起源。超过75%的病例中缺血性坏死累及股骨头。尽管缺血性坏死是不可逆的，但必须寻找许多危险因素，包括皮质类固醇治疗、高胆固醇血症、镰状细胞病或酗酒。MRI成像检查是该病诊断和分期的主要手段，对于X线检查正常的年轻患者出现无法解释的髋部疼痛时应进行此项检查。在疾病的早期阶段（阿莱特和菲卡特分类法的I期和II期），关节面保持完整，建议采取保守治疗。在更晚期阶段（阿莱特和菲卡特分类法的III期和IV期），关节面塌陷，关节置换术是主要治疗方法。然而，基于间充质干细胞的一些最新治疗进展，未来可能有助于改善该病不良的功能预后。
