陈宝琅

[摘要]在骨科临床诊断治疗过程中，股骨头坏死是一项比较困难的课题，在临床诊疗过程中过多地使用激素类药物，使得该病的发病率也在逐渐提升。目前，该病的发病机制尚未完全明确，存在着一定争议。激素性股骨头坏死的治疗方式还处于探索阶段，还不能够从病因学的角度来展开有效的治疗干预。有研究在坏死的股骨头标本中发现了凋亡细胞，这使人们的注意力也转向了对细胞凋亡领域的研究。本文对细胞凋亡与激素性股骨头坏死发病机制之间存在的联系进行综述。

[关键词]激素性股骨头坏死；发病机制；细胞凋亡；研究进展

[中图分类号] R681.8 [文献标识码] A [文章编号] 1674-4721（2016）07（a）-0012-04

[Abstract]In the process of clinical diagnosis and treatment in the department of orthopedics，the necrosis of the femoral head is a difficult task，due to excessive use of glucocorticoid in the clinical diagnosis and treatment process，the incidence rate of glucocorticoid-induced necrosis of the femoral head is gradually improving.At present，the pathogenesis of the glucocorticoid-induced necrosis of the femoral head is not completely clear，there is a certain controversy.The treatment of glucocorticoid-induced necrosis of the femoral head is still in the exploratory stage，and it is not able to expand effective therapeutic intervention from the view of etiology.Apoptosis have been found in the necrotic femoral head，which has turned the attention of people to the field of apoptosis.The relationship between apoptosis and the pathogenesis of glucocorticoid-induced necrosis of the femoral head is reviewed in this paper.

[Key words]Glucocorticoid-induced necrosis of the femoral head；Pathogenesis；Cell apoptosis；Research progress

股骨头坏死是一种比较常见的骨科疾病类型之一，如果不能得到及时医治，最终可能会使患者选择髋骨关节假体置换[1]来抑制病情的恶化。目前，我国股骨头坏死的人数为500万～750万，每年新增患者数能够达到7万～15万，造成这一结果的最主要原因可能是在临床诊疗过程中过多地使用激素类药物。激素可导致股骨头坏死的观点早在20世纪50年代就已确立，在非创伤性股骨头坏死中，因过多使用激素性药物导致股骨头坏死的发病率占首位，但发病机制目前尚不明确。有学者[2]分析，其可能和脂肪代谢紊乱、凝血、骨内高压、免疫系统紊乱、细胞凋亡等客观因素存在一定关联。随着分子生物学的不断发展，就激素性股骨头坏死而言，国内外学者也纷纷将注意力转移到对细胞凋亡理论的研究，并认为骨细胞、成骨细胞的凋亡在激素性股骨头缺血坏死中扮演着重要角色。……