Hofmann S, Kramer J, Leder K, Plenk H, Engel A
Orthopädisches Krankenhaus Gersthof, 1. Abteilung, Wien.
Radiologe. 1994 Jan;34(1):1-10.
Intraosseous vascularization is the common pathway of the multifactorial causes of avascular necrosis of the hip (AVN). Recurring ischemic phases could lead to bone necrosis in the initial stage of the disease, when it is still reversible. A spontaneous repair mechanism can lead to complete healing at this stage. The necrotic area demarcates the superior-anterior aspect from the residual femoral head with a reactive interface in the irreversible early stage of the disease. In this stage damage to the femoral head can only be delayed with core decompression or femoral osteotomy, because a sufficient repair mechanism is no longer possible. When the articular surface collapses the early stage gives way to the late stage. Cartilage incongruence and microfracture lead to progressive destruction of the femoral head and to secondary osteoarthritis. In this late stage femoral osteotomy is only successful in carefully selected patients. Total hip replacement is the last resort for patients with painful destruction of the joint. As clinical symptoms are unspecific, MRI plays an important role for early diagnosis of AVN in the initial or early stages. Conservative treatment is not successful in any of the three stages of the disease.
骨内血管化是髋部缺血性坏死（AVN）多因素病因的共同途径。反复出现的缺血期可在疾病的初始阶段导致骨坏死，此时病变仍可逆。自发修复机制可在该阶段导致完全愈合。在疾病不可逆的早期阶段，坏死区域通过反应界面将股骨头的上前方与残余股骨头区分开来。在这个阶段，只能通过髓芯减压或股骨截骨术来延缓股骨头的损伤，因为充分的修复机制已不再可能。当关节面塌陷时，早期就会进入晚期。软骨不匹配和微骨折会导致股骨头的渐进性破坏和继发性骨关节炎。在这个晚期阶段，股骨截骨术仅在精心挑选的患者中取得成功。全髋关节置换术是关节疼痛性破坏患者的最后手段。由于临床症状不具特异性，MRI在AVN初始或早期阶段的早期诊断中起着重要作用。保守治疗在疾病的三个阶段中均未取得成功。
