Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Guizhou University of Traditional Chinese Medicine, Guiyang, China.
Orthop Surg. 2020 Dec;12(6):1776-1783. doi: 10.1111/os.12810. Epub 2020 Oct 15.
To investigate the application of treatment modalities for patients with osteonecrosis of the femoral head (ONFH) in mainland China.
This cross-sectional study was based on the online application of China Osteonecrosis of the Femoral Head Database (CONFHD). Between July 2016 to December 2018, the CONFHD program planned to recruit ONFH patients from 12 administrative areas across mainland China. Real-world medical records of treatment regimens for these patients, including surgeries and prescriptions, were approved to upload to the CONFHD application for further analysis. The surgeries performed on these patients were classified into total hip arthroplasty and hip-preserving procedures, and the latter was further classified into core decompression, bone grafting, and tantalum rod implantation. Prescription medications were classified into chemical medicine and Chinese herbal medicine (CHM); chemical medicine was further classified according to their chemical compounds, and CHM was classified according to therapeutic functions based on traditional Chinese medicine theory. Descriptive analysis was performed to summarize the application of different treatment regimens on the overall sample.
A total of 1491 patients (2381 hips) who fulfilled the protocol criteria were included. There were 1039 males and 452 females with a mean age of 47.29 ± 12.69 years. The causes of ONFH were alcoholism in 642 patients (43%), corticosteroid in 439 patients (29%), trauma in 239 patients (16%), and idiopathic ONFH in 171 patients (11%). Operative treatments (including total hip arthroplasty and hip-preserving procedures) were performed on 49% of patients (43% of hips), chemical medicine therapy (including bisphosphonate, statins, and prostacyclin) was given to 37% of patients (37% of hips), and CHM was administrated to 72% of patients (75% of hips). The aforementioned interventions were not always used alone, since 47% of patients (52% of hips) received combined regimens with multiple interventions. Among hips treated by surgery, all hips with ARCO stage IV ONFH received THA (305 hips), and THA was also performed on 63 hips with stage II ONFH. Over half of hips with stage I (81%), II (91%), and III (92%) ONFH had received pharmacological treatments. Prostacyclin and bisphosphonate were the top two most prescribed medicines used alone. CHM therapies with multiple CHM functions were more commonly prescribed.
Current treatment modalities for ONFH patients in mainland China include operative treatment, chemical medicine, and CHM. Combined regimens with different treatment modalities are common in real-world clinical practices.
研究中国大陆地区股骨头坏死（ONFH）患者的治疗方式应用情况。
本研究为一项横断面研究，基于中国股骨头坏死数据库（CONFHD）在线应用程序开展。2016 年 7 月至 2018 年 12 月间，CONFHD 计划从中国大陆 12 个行政区域招募 ONFH 患者。该研究对患者治疗方案的真实医疗记录（包括手术和处方）进行了审批，并允许将其上传至 CONFHD 应用程序，以进行进一步分析。患者接受的手术分为全髋关节置换术和保髋手术，后者进一步分为核心减压、植骨和钽棒植入术。处方药物分为化学药物和中药（CHM）；化学药物根据其化学结构进一步分类，而 CHM 根据中药理论的治疗功能进行分类。采用描述性分析总结了总体样本中不同治疗方案的应用情况。
共纳入 1491 例（2381 髋）符合方案标准的患者，其中男性 1039 例（68%），女性 452 例（32%），平均年龄为 47.29±12.69 岁。ONFH 的病因包括酒精性 642 例（43%）、皮质类固醇性 439 例（29%）、创伤性 239 例（16%）和特发性 171 例（11%）。49%的患者（43%的髋部）接受了手术治疗（包括全髋关节置换术和保髋手术），37%的患者（37%的髋部）接受了化学药物治疗（包括双磷酸盐、他汀类药物和前列环素），72%的患者（75%的髋部）接受了中药治疗。上述干预措施并非总是单独使用，因为 47%的患者（52%的髋部）接受了多种干预措施的联合治疗。在接受手术治疗的髋部中，所有 ARCO 分期为 IV 期的 ONFH 髋部均接受了全髋关节置换术（305 髋），2 期 ONFH 髋部也接受了全髋关节置换术（63 髋）。超过一半的 I 期（81%）、II 期（91%）和 III 期（92%）ONFH 髋部接受了药物治疗。单独使用前列环素和双磷酸盐是最常用的两种药物。具有多种中药功能的中药治疗更为常用。
中国大陆地区股骨头坏死患者的治疗方式包括手术治疗、化学药物治疗和中药治疗。在真实临床实践中，联合应用不同治疗方式的联合方案较为常见。
