Ficat R P
Hip. 1983:279-95.
We believe that all bone necrosis passes through a preradiologic stage, which is either painful and therefore Stage I or asymptomatic and therefore Stage O. Moreover, the diagnosis of osteonecrosis cannot be made by standard x-ray technique, which means that a normal x-ray examination does not guarantee that the hip is normal. The diagnosis in the early stage can be made only through the functional exploration of bone. In spite of multiple etiologies, there exists a pathophysiologic unity that centers around the circulatory disorder and is dominated by stasis. We believe that this explains the clinical and radiologic similarity of diverse causes of ischemic necrosis of bone. The medical treatment, preventive or prophylactic, is based on the causes and therefore is specific to the etiology of the avascular necrosis, whether that be cessation of drinking alcohol or reduction of steroid therapy. The interruptive treatment, however, which aborts the progression of the disease, rests on early diagnosis and core decompression. This dependence of results of treatment on timing has also been borne out by other authors as well, including Hungerford and Zizic and Marcus et al.
我们认为，所有骨坏死都会经历一个放射学前期阶段，该阶段要么疼痛，即为I期，要么无症状，即为O期。此外，骨坏死无法通过标准X线技术诊断，这意味着X线检查结果正常并不能保证髋关节正常。早期诊断只能通过骨的功能探查来进行。尽管病因多样，但存在一个以循环障碍为核心、以瘀血为主导的病理生理统一性。我们认为，这解释了不同原因导致的骨缺血性坏死在临床和放射学上的相似性。无论是预防性还是预防性的医学治疗，都基于病因，因此针对无血管坏死的病因具有特异性，无论是戒酒还是减少类固醇治疗。然而，阻止疾病进展的阻断性治疗则依赖于早期诊断和髓芯减压。其他作者，包括亨格福德、齐齐克和马库斯等人，也证实了治疗结果对时机的这种依赖性。
