Chang C C, Greenspan A, Gershwin M E
Division of Rheumatology, Allergy, and Clinical Immunology, University of California, Davis.
Semin Arthritis Rheum. 1993 Aug;23(1):47-69. doi: 10.1016/s0049-0172(05)80026-5.
Nontraumatic osteonecrosis results from impairment of circulation to the affected bone. The femoral head is affected most frequently. The underlying cause for the circulatory defect in osteonecrosis varies and may involve both local and systemic changes. Steroid use, alcohol consumption, pancreatitis, and lipid disorders appear to lead to bone death either by development of fat emboli in the microcirculature surrounding the affected bone or by fatty infiltration of the marrow. Decompression syndrome results from the presence of gaseous emboli in the microcirculature. In Legg-Calvé-Perthes disease other associated features are present such as short stature, suboptimal growth velocity, and/or hormonal imbalances, and it is likely that osteonecrosis may be secondary to systemic abnormalities, although specific factors have not been identified. Other frequently suggested pathogenic factors that play a role in the development of osteonecrosis include increased intraosseous pressures, the presence of cytotoxic cellular factors, intravascular coagulation, venous stasis, and the hyperviscosity syndrome. Some investigators have attempted, without success, to find a common etiology for all cases of osteonecrosis. In addition, patients have developed osteonecrosis without any known risk factors; this syndrome has been coined idiopathic avascular necrosis. In advanced stages of femoral head osteonecrosis, total hip arthroplasty appears to be the best therapeutic modality, particularly in older individuals.
非创伤性骨坏死是由受影响骨骼的血液循环受损所致。股骨头最常受累。骨坏死中循环缺陷的潜在原因各不相同，可能涉及局部和全身变化。使用类固醇、饮酒、胰腺炎和脂质紊乱似乎通过在受影响骨骼周围的微循环中形成脂肪栓子或通过骨髓脂肪浸润导致骨坏死。减压综合征是由微循环中存在气体栓子引起的。在Legg-Calvé-Perthes病中，还存在其他相关特征，如身材矮小、生长速度不理想和/或激素失衡，尽管尚未确定具体因素，但骨坏死可能继发于全身异常。其他经常被认为在骨坏死发展中起作用的致病因素包括骨内压升高、细胞毒性细胞因子的存在、血管内凝血、静脉淤滞和高黏滞综合征。一些研究人员试图为所有骨坏死病例找到一个共同的病因，但未成功。此外，患者在没有任何已知危险因素的情况下也会发生骨坏死；这种综合征被称为特发性缺血性坏死。在股骨头骨坏死的晚期，全髋关节置换术似乎是最佳治疗方式，尤其是在老年患者中。
