股骨头坏死血供障碍分期在股骨头坏死治疗中的指导意义  

Guiding significance of staging of osteonecrosis of the femoral head blood supply disorder in the treatment of osteonecrosis of the femoral head

作　　者：赵德伟[1] 范德超 Zhao Dewei;Fan Dechao(Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China)

机构地区：[1]大连大学附属中山医院骨一科,116001

出　　处：《中华损伤与修复杂志（电子版）》2020年第2期153-155,共3页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘　　要：股骨头坏死(ONFH)是临床常见疾病,主要分为创伤性ONFH与非创伤性ONFH。创伤性ONFH主要由于供养股骨头的动脉在外力作用下损伤或断裂,直接破坏了股骨头的血供。非创伤性ONFH主要有皮质类固醇类药物应用、长期饮酒过量、减压病、血红蛋白病等多种病因。对主要致病因素进行骨坏死造模并行病理学研究发现,各种致病因素通过共同的途径——血管内凝血、静脉瘀滞、骨内压增高、动脉受损、股骨头缺血坏死导致ONFH。在体外,通过用微计算机断层扫描技术(Micro-CT)扫描灌注纳米硫酸钡的离体股骨头标本建立血运模型,在体内对患者采用超选择数字减影血管造影(DSA)来观察不同骨坏死股骨头内血运,结合两者的影像学表现及临床症状,笔者提出了ONFH血供障碍分期理论,并应用于临床上各阶段ONFH的诊疗,针对不同血供障碍分期的ONFH采取相应治疗措施,取得了良好的临床疗效,对于ONFH的诊疗具有指导性意义。Osteonecrosis of the Femeral Head(ONFH)is a common clinical disease,mainly divided into traumatic osteonecrosis and non-traumatic osteonecrosis.Traumatic ONFH is mainly due to the rupture of the artery feeding the femoral head under the action of external force,which directly destroys the blood supply of the femoral head.The main causes of non-traumatic femoral head necrosis include corticosteroid application,long-term alcohol overdose,decompression sickness,hemoglobin disease,etc.Pathogenesis is divided into the following processes:intravascular coagulation,venous stasis,increased intraosseous pressure,arterial injury,ischemic necrosis of the femoral head.In vitro,micro computed tomography(Micro-CT)scan of isolated femoral head specimens infused with nano-barium sulfate have been used to establish a blood transport model.In vivo digital subtraction angiography(DSA)have been used to observe blood flow in femoral heads with different osteonecrosis.Combining the images performance and the clinical symptoms,the author puts forward the staging theory of blood supply disorder of ONFH and applies it to the diagnosis and treatment of ONFH at various clinical stages.

关 键 词：股骨头坏死 髋关节 血供障碍分期 治疗策略 

分 类 号：R68[医药卫生—骨科学]