股骨头坏死保髋治疗常用术式的利与弊

Gu Changyuan, Master candidate, First Clinical School of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
Corresponding author: Du Bin, Professor, Chief physician, Doctoral supervisor, Department of Orthopedics and Traumatology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
顾长源，男，1994 年生， 江苏省南京市人，汉族， 南京中医药大学第一临床 医学院在读硕士，主要从 事骨与关节病研究。
通讯作者：杜斌，教授， 主任医师，博士生导师， 南京中医药大学附属医院 骨伤科，江苏省南京市 210029
文献标识码:A 投稿日期：2019-09-23 送审日期：2019-10-10 采用日期：2019-12-05 在线日期：2020-02-17
ORCID: 0000-0001-6117-6147(顾长源)
210029；2南京中医药大学附属医院
文章快速阅读：
文章特色— (1)通过文献检索及总结，探究除股骨头坏死分期之外，是否有术式本身或其他内、外源性因素影响
保留髋关节手术的成功率，并将各类因素列举总结； (2)对各类保髋术式的适应证选择和其利弊进行归纳概括，并提出该种术式的改进措施及注意要点；
3379
顾长源，杜斌，孙光权，刘锌，吕排云. 股骨头坏死保髋治疗常用术式的利与弊[J]. 中国组织工程研究，2020，24(21):3379-3386. DOI:10.3969/j.issn.2095-4344.2654
Abstract BACKGROUND: There are many methods for the treatment of non-traumatic necrosis of the femoral head. In the clinical treatment, various stages of necrosis are the decisive factors for the choice of operation. In the past, there are many studies about the effectiveness of various techniques, but few studies concern the causes of failure or risk assessment. OBJECTIVE: To explore whether other internal and external factors affect the success rate of hip preservation besides necrosis stage. METHODS: The first author retrieved PubMed, Web of Science, Medline, CNKI and Wanfang database for related studies published from 2010 to 2019. The key words were “osteonecrosis of femoral head, core decompression, non-vascularized bone grafting, vascularized free bone grafting, porous tantalum rod implantation, osteotomy, biological agents, cytotherapy” in English, and “hip-conserving surgery, hip preservation, core decompression, bone graft without blood vessel, bone graft with blood vessel, porous tantalum rod placement, osteotomy, biologics, cell therapy” in Chinese. A total of 214 articles were retrieved, and the full text was consulted. Based on the inclusion and exclusion criteria, 70 articles were finally included for analysis and summary. RESULTS AND CONCLUSION: (1) The advantages and disadvantages of each hip-conserving surgery should be evaluated. (2) Although core decompression is simple, it should not be used alone; the lateral column should be reserved properly when the non-vascularized bone transplantation is used to clean up the dead bone, so as to deal with the mechanical weakening; the blood loss and fracture risk are higher when the vascularized bone transplantation is converted to total hip replacement; the stress concentration is easily caused by tantalum rod implantation, and the clinical application is less. (3) Osteotomy, as a kind of hip-conserving surgery with great trauma, should be planned in detail for patients’ age, body mass index, and necrotic range, besides considering the necrotic stage. (4) The risk of total hip replacement should be considered in the long run no matter which operation. (5) The combination of various surgical methods and biological agents may achieve better results. Key words: osteonecrosis of femoral head; hip-conserving surgery; advantages and disadvantages; clinic; review Funding: the Research and Practice Innovation Program for Postgraduates in Jiangsu Province, No. SJCX19_0387 (to GCY)
以失败病例为基础，对保髋术式的联合运用和远期翻修做出展望。
背景： (1) 保 髋 手 术 种 类
众多，且各有利
弊； (2)如何在各术式中
正确选择wk.baidu.com结合
失败病例有何经 验教训？
综述
研究方向：
(1)常用保髋术式的优势 和弊端；
(2)正确的患者选择和远 期翻修难度；
(3) 与 生 物 制 剂 联 合 运 用。
Advantages and disadvantages of common methods of hip-conserving surgery for osteonecrosis of femoral head
Gu Changyuan1, Du Bin2, Sun Guangquan2, Liu Xin2, Lü Paiyun1 (1First Clinical School of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China; 2Department of Orthopedics and Traumatology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China)
《中国组织工程研究》 Chinese Journal of Tissue Engineering Research
股骨头坏死保髋治疗常用术式的利与弊
·综述·
顾长源1，杜 斌2，孙光权2，刘 锌2，吕排云1 (1南京中医药大学第一临床医学院，江苏省南京市
骨伤科，江苏省南京市 210029)
DOI:10.3969/j.issn.2095-4344.2654
摘要 背景：非创伤性股骨头坏死的保留髋关节治疗方法众多，临床治疗中多以各类坏死分期作为术式选择的决 定性因素。以往的相关文献对各类术式有效性的分析较多，但对于失败原因或风险评估介绍较少。 目的：探讨除了坏死分期之外，对于术式本身是否有其他内、外源因素也同时影响了保髋成功率。 方法：由第一作者检索 2010 至 2019 年 PubMed、Web of Science、Medline、知网、万方数据库中相关 文献，检索词为“osteonecrosis of femoral head，core decompression，non-vascularized bone grafting， vascularized free bone grafting，porous tantalum rod implantation，osteotomy，biological agents， cytotherapy，保留髋关节手术，保髋术，髓芯减压术，不带血管的骨移植术，带血管的骨移植术，多孔钽 棒置入术，截骨术，生物制剂，细胞疗法”。共检索到 214 篇文献，查阅全文，依据纳入与排除标准，最 终纳入 70 篇文献进行分析总结。 结果与结论：①各保髋术式均有利弊，须评估利弊风险；②髓芯减压虽操作简单，却不宜单独使用；非血 管化骨移植在死骨清理时应适当保留外侧柱，以应对力学减弱；带血管的骨移植转为全髋关节置换术中失 血较多、骨折风险较高；钽棒置入易造成应力集中，临床应用较少；③截骨术作为一种创伤较大的保髋手 术除了考虑坏死分期外，对患者年龄、体质量指数、坏死范围等均应做详细术前规划；④无论哪种术式， 都应长远考虑转为全髋关节置换的手术风险；⑤各术式联合应用，结合生物制剂或能取得更好的疗效。 关键词： 股骨头坏死；保髋手术；利弊分析；临床；综述 中图分类号：R459.9；R318；R687 基金资助： 江苏省研究生科研与实践创新计划项目(SJCX19_0387)，项目负责人：顾长源
意义：
(1)总结常用术式的适应 证和患者选择；
(2)总结术式弊端和术中 注意要点；
(3)重视远期翻修难度， 长远考虑保髋“性价
比”。
文题释义： 股骨头坏死：非创伤性股骨头坏死是造成青壮年髋关节功能障碍或功能丧失的常见疾病，其病因主要为糖 皮质激素的大量应用和酒精的过多摄入，根据坏死分期和患髋情况可选择不同的治疗方案，目前此疾病尚 无令人满意的完全性治疗手段，延迟或避免关节置换成为主流研究方向。 保留髋关节手术：为延迟或避免行全髋关节置换的一类治疗方法。保髋术式类型较多，针对不同坏死类型 可选择不同术式，且各有利弊。现多将多种术式联合应用，取长补短，以达到最好疗效。随着生物制剂和 细胞疗法的不断发展，保髋手术与其结合正成为新的趋势。