William Beaumont Army Medical Center, El Paso, TX, USA; Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.
William Beaumont Army Medical Center, El Paso, TX, USA; Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Hand Clin. 2022 Nov;38(4):367-376. doi: 10.1016/j.hcl.2022.03.011.
Avascular necrosis is a complicated, multifactorial disease with potentially devastating consequences. Although the underlying root cause is a lack of appropriate vascular perfusion to affected bone, there are often varying patient-specific, anatomic-specific, and injury-specific predispositions. These factors generally fall into 3 categories: direct vascular disruption, intravascular obliteration, or extravascular compression. The initial stages of disease can be insidiously symptomatic because edematous bone marrow progresses to subchondral collapse and subsequent degenerative arthritis. Although much of the current literature focuses on the femoral head, other common areas of occurrence include the proximal humerus, knee, and the carpus. The low-incidence rate of carpal avascular necrosis poses a challenge in establishing adequately powered, control-based validated treatment options, and therefore, optimal surgical management remains a continued debate among hand surgeons. Appreciation for expectant fracture healing physiology may help guide future investigation into carpal-specific causes of avascular necrosis.
骨坏死是一种复杂的、多因素的疾病，可能会产生灾难性的后果。尽管根本原因是受影响的骨骼缺乏适当的血管灌注，但通常存在不同的患者特异性、解剖特异性和损伤特异性易感性。这些因素通常分为 3 类：直接血管破裂、血管内闭塞或血管外压迫。疾病的早期阶段可能症状隐匿，因为水肿的骨髓进展为软骨下塌陷和随后的退行性关节炎。尽管目前的大部分文献都集中在股骨头，但其他常见的发病部位包括肱骨近端、膝关节和腕关节。腕关节骨坏死的低发生率给建立足够有力的、基于对照的验证治疗方案带来了挑战，因此，最佳的手术治疗仍然是手部外科医生持续争论的话题。对预期骨折愈合生理学的认识可能有助于指导对腕关节骨坏死的特定原因的未来研究。
