Leandro Márcio Passos, De Sá Cloud Kennedy Couto, Filho Diógenes Pires Serra, De Souza Lucas Azevedo Alves, Salles Cristina, Tenório Mario Cesar Carvalho, Paz Cláudio Luiz Da Silva Lima, Matos Marcos Antônio Almeida
Hospital Geral Ernesto Simões Filho, Praça Conselheiro João Alfredo, s/n - Caixa D'agua, Salvador-Bahia, 40301-155 Brazil.
Bahiana School of Medicine and Public Health, Salvador-Bahia, Brazil.
Indian J Orthop. 2021 Aug 4;56(2):216-225. doi: 10.1007/s43465-021-00469-4. eCollection 2022 Feb.
The objective was to evaluate the level of evidence about the associated factors and the risk factors of osteonecrosis of femoral head (ONFH) in sickle cell individuals.
The review was based on the search and selection of studies available in the electronic databases PubMed, SCIELO, LILACS, BVS. As descriptors, the terms of Medical Subject Headings (MeSH) and Health Sciences Descriptors (DeCS) corresponding to "Osteonecrosis", "Necrosis avascular" and "Aseptic necrosis" and "Femoral head" and "sickle cell disease" and "risk factor" and "predictor".
Among clinical and laboratorial factors the most promising risk factors were the severity of sickle cell disease and acute chest syndrome. As a result, from studies of a moderate level of quality, blood pressure, body weight, previous trauma, haemoglobin to haematocrit ratio (Hb/HCT), and number of hospitalizations can be highlighted. Others, such as genetic markers and male gender, have also been positively associated in lower quality studies.
For a better clarification of what the risk factors are for the ONFH, it is necessary to study with populations of different origins, different ages, different profiles of Hb, which present greater methodological rigor and perform a multivariate analysis to control confounding factors. Further study is also needed to understand the genetic determinants of ONFH.
评估有关镰状细胞病患者股骨头坏死（ONFH）相关因素和危险因素的证据水平。
该综述基于对电子数据库PubMed、SCIELO、LILACS、BVS中现有研究的检索和筛选。作为描述词，使用了与“骨坏死”、“无血管坏死”、“无菌性坏死”以及“股骨头”、“镰状细胞病”、“危险因素”和“预测因素”相对应的医学主题词（MeSH）和健康科学描述词（DeCS）。
在临床和实验室因素中，最有前景的危险因素是镰状细胞病的严重程度和急性胸部综合征。因此，从质量中等水平的研究中，可以突出血压、体重、既往创伤、血红蛋白与血细胞比容比值（Hb/HCT）以及住院次数。其他因素，如基因标记和男性性别，在质量较低的研究中也有正相关报道。
为了更好地阐明ONFH的危险因素有哪些，有必要对不同来源、不同年龄、不同血红蛋白谱的人群进行研究，这些研究要有更高的方法学严谨性，并进行多变量分析以控制混杂因素。还需要进一步研究以了解ONFH的基因决定因素。
