Core decompression-based strategies for treatment of the early osteonecrosis of the femoral head

doi:10.3877/cma.j.issn.1673-9450.2020.02.013

Abstract

Abstract:

Treatment of osteonecrosis of the femoral head (ONFH) continues to be a scientific challenge. Early ONFH treatment was aimed at alleviating symptoms, improving hip function, delaying its progression and preventing the collapse of the femoral head. Core decompression-based strategies may be effective solutions of joint preservation for early ONFH. Over the past decades, core decompression-based strategies have shown encouraging outcomes, but they are still controversial. The article reviews the latest research progresses, analyzes the advantages and disadvantages of core decompression (CD), multiple drilling, CD+ non-vascularized bone-grafting, CD+ vascularized bone-grafting, CD+ tantalum implants, CD+ synthetic bone substitutes, CD+ bone mesenchymal stem cell and CD+ platelet-rich plasma, and gives some future perspectives for the treatment of ONFH, so as to provide references for clinical decision-making.

Key words: Decompression, Femur head necrosis, Hip-joint, Hip-preserving surgery

Dejin Yang, Mingxue Chen, Xiaozhong Guo, Yixin Zhou. Core decompression-based strategies for treatment of the early osteonecrosis of the femoral head[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2020, 15(02): 146-152.

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URL: https://zhssyxfzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1673-9450.2020.02.013

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References 79

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?	?	分期	临床表现	影像学表现	血流动力学	骨显像	不经穿刺活检确定诊断
早期	0	临床前期	0	0	＋	摄取减少	不能
	Ⅰ	影像学前期	＋	0	＋＋	摄取增加	不能
	Ⅱ	股骨头扁平或成死骨形成前期	＋	散在的硬化和囊性变	＋＋	＋	很大可能
转变期	?	?	?	股骨头扁平或新月征	?	?	?
晚期	Ⅲ	塌陷	＋＋	股骨头轮廓改变	＋/正常	＋	确诊
晚期	Ⅳ	骨关节炎	＋＋＋	股骨头扁平、关节间隙正常/股骨头塌陷、关节间隙减小	＋	＋	关节炎

?	?	分期	临床表现	影像学表现	血流动力学	骨显像	不经穿刺活检确定诊断
早期	0	临床前期	0	0	＋	摄取减少	不能
	Ⅰ	影像学前期	＋	0	＋＋	摄取增加	不能
	Ⅱ	股骨头扁平或成死骨形成前期	＋	散在的硬化和囊性变	＋＋	＋	很大可能
转变期	?	?	?	股骨头扁平或新月征	?	?	?
晚期	Ⅲ	塌陷	＋＋	股骨头轮廓改变	＋/正常	＋	确诊
晚期	Ⅳ	骨关节炎	＋＋＋	股骨头扁平、关节间隙正常/股骨头塌陷、关节间隙减小	＋	＋	关节炎

分期	判断标准
0	影像学平片、骨扫描和MRI均正常
Ⅰ	平片正常，骨扫描和/或MRI异常
	A：轻微 —— <15%股骨头累及
	B：中等 —— 15%～30%股骨头累及
	C：重度 —— >30%股骨头累及
Ⅱ	股骨头囊性变和硬化灶
	A：轻微 —— <15%股骨头累及
	B：中等 —— 15%～30%股骨头累及
	C：重度 —— >30%股骨头累及
Ⅲ	股骨头软骨下骨塌陷、新月征、股骨头未扁平
	A：轻微 —— <15%股骨头累及
	B：中等 —— 15%～30%股骨头累及
	C：重度 —— >30%股骨头累及
Ⅳ	股骨头扁平
	A：轻微 —— <15%股骨头累及或塌陷<2 mm
	B：中等 —— 15%～30%股骨头累及或塌陷2～4 mm
	C：重度 —— >30%股骨头累及或塌陷>4 mm
Ⅴ	关节间隙狭窄、髋臼累及
	A：轻微
	B：中等
	C：重度
Ⅵ	髋关节严重退行性改变

分期	判断标准
0	影像学平片、骨扫描和MRI均正常
Ⅰ	平片正常，骨扫描和/或MRI异常
	A：轻微 —— <15%股骨头累及
	B：中等 —— 15%～30%股骨头累及
	C：重度 —— >30%股骨头累及
Ⅱ	股骨头囊性变和硬化灶
	A：轻微 —— <15%股骨头累及
	B：中等 —— 15%～30%股骨头累及
	C：重度 —— >30%股骨头累及
Ⅲ	股骨头软骨下骨塌陷、新月征、股骨头未扁平
	A：轻微 —— <15%股骨头累及
	B：中等 —— 15%～30%股骨头累及
	C：重度 —— >30%股骨头累及
Ⅳ	股骨头扁平
	A：轻微 —— <15%股骨头累及或塌陷<2 mm
	B：中等 —— 15%～30%股骨头累及或塌陷2～4 mm
	C：重度 —— >30%股骨头累及或塌陷>4 mm
Ⅴ	关节间隙狭窄、髋臼累及
	A：轻微
	B：中等
	C：重度
Ⅵ	髋关节严重退行性改变

分期	发现	检查技术	亚型
0	所有的检查技术均阴性	X线/CT/骨显像/MRI	无	?	?
Ⅰ	X线和CT正常，骨显像/MRI异常	骨显像/MRI；MRI可定量	IA：股骨头受累<15%	IB：股骨头受累15%～30%	IC：股骨头受累>30%
Ⅱ	无"新月征"。异常X线表现为硬化、局灶性骨溶解	X线/CT/骨显像/MRI MRI和X线均可定量	ⅡA：股骨头受累<15%	ⅡB：股骨头受累15%～30%	ⅡC：股骨头受累>30%
Ⅲ	X线示"新月征"，或股骨头关节面扁平	X线/CT；X线可定量	ⅢA：新月征<15%或股骨头塌陷<2 mm	ⅢB：新月征15%～30%或股骨头塌陷2～4 mm	ⅢB：新月征>30%或股骨头塌陷>4 mm
Ⅳ	骨关节炎表现。关节间隙狭窄、髋臼累及、关节破坏	仅X线	无	?	?

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