Karampinas Panagiotis, Galanis Athanasios, Papagrigorakis Eftychios, Vavourakis Michail, Vlachos Christos, Zachariou Dimitrios, Pneumaticos Spiros, Vlamis John
3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece.
Maedica (Bucur). 2022 Dec;17(4):948-954. doi: 10.26574/maedica.2022.17.4.948.
Osteonecrosis of the femoral head (ONFH) is a debilitating condition with various etiologies. Comprehension of the pathophysiology of the disease is limited, adding to the challenge of devising a clinically effective treatment strategy. High clinical suspicion and magnetic resonance imaging aid early diagnosis, leading to less invasive and more effective treatment. Recent advancements in joint-preserving surgical treatment have led to improved outcomes, reduced pain, and a higher hip survival rate for early onset osteonecrosis of the femoral head compared with more invasive approaches such as total hip replacement. Core decompression is the gold standard procedure to relieve the ischemic area of the femoral head and is crucial in the early stage of osteonecrosis. The addition of biologic regenerative agents to core decompression is auspicious as they can introduce new cells to the area of necrosis, osteoinductive and osteoconductive agents, while enhancing healing and cellular repair. Adjunctive bone marrow-derived cell therapies have been advocated, potentially aiding the regenerative process. Arthroscopic core decompression and robot-assisted orthopaedic surgery are believed to improve the precision of graft placement, decreasing radiation and operative time. The current study provides a comprehensive review and update of the literature surrounding the latest developments regarding joint-preserving surgical treatment for patients with osteonecrosis of the femoral head.
股骨头坏死（ONFH）是一种病因多样的使人衰弱的病症。对该疾病病理生理学的理解有限，这增加了制定临床有效治疗策略的挑战。高度的临床怀疑和磁共振成像有助于早期诊断，从而实现侵入性更小、更有效的治疗。与全髋关节置换等侵入性更强的方法相比，保关节手术治疗的最新进展已使早期股骨头坏死患者的治疗效果得到改善、疼痛减轻且髋关节生存率更高。髓芯减压是缓解股骨头缺血区域的金标准手术，在坏死早期至关重要。在髓芯减压中添加生物再生剂是有益的，因为它们可以将新细胞引入坏死区域，即骨诱导和骨传导剂，同时促进愈合和细胞修复。辅助性骨髓源细胞疗法已得到提倡，可能有助于再生过程。关节镜下髓芯减压和机器人辅助骨科手术被认为可提高移植物放置的精度，减少辐射和手术时间。本研究对围绕股骨头坏死患者保关节手术治疗最新进展的文献进行了全面综述和更新。
