Glueck Charles J
Cholesterol, Metabolism, and Thrombosis Research Center, Middleton Ave, 3906, Cincinnati, OH, USA.
Orthopadie (Heidelb). 2025 May;54(5):376-385. doi: 10.1007/s00132-024-04606-3. Epub 2025 Feb 19.
Anticoagulation in most patients with familial thrombophilia-hypofibrinolysis and primary osteonecrosis (ON) before hip or knee collapse relieves pain, prevents joint collapse and usually averts the need for joint replacement but is not successful in secondary ON or if started after joint collapse. Anticoagulation in Perthes disease and in ON acutely appearing in post-COVID patients, particularly when factor V Leiden is present, may be valuable as an approach to prevent the otherwise high likelihood of subsequent joint failure. Anticoagulation in primary ON with concurrent thrombophilia-hypofibrinolysis should be considered within the treatment spectrum of ON.
对于大多数患有家族性血栓形成倾向-低纤维蛋白溶解症和原发性骨坏死（ON）且髋关节或膝关节尚未塌陷的患者，抗凝治疗可缓解疼痛、预防关节塌陷，并通常可避免关节置换的需要，但对于继发性骨坏死或在关节塌陷后开始抗凝治疗则无效。在佩特兹病以及新冠后急性出现骨坏死的患者中，尤其是存在因子V莱顿突变时，抗凝治疗作为一种预防随后关节功能衰竭高可能性的方法可能是有价值的。原发性骨坏死合并血栓形成倾向-低纤维蛋白溶解症时，抗凝治疗应纳入骨坏死的治疗范畴。
