潘风雨 张涌泉

摘 要：股骨头坏死是一种常发生于青壮年人群的高致残性疾病。在股骨头塌陷前的早期阶段，通常选用保留髋关节的手术治疗，但保髋治疗的手术方式很多，如何恰当的选择治疗方式是医生必须面对的难题。“血液循环障碍”是股骨头坏死的共同病理特征，保髋手术的出发点就是要解决这一问题，其理想的手术方式需要实现以下四个治疗目标：去除死骨和纤维肉芽组织，改善股骨头血液循环，提供结构支撑，促进新骨生成。在当前的技术条件下，“病灶清除+有血运的骨移植术”能够同时实现这四个治疗目标，成为治疗青壮年人群早期股骨头坏死的理想方式，其中又以“病灶清除+带血管蒂的髂骨移植术”为最佳。

关键词：股骨头坏死；青壮年；保髋治疗；带蒂髂骨块移植

中图分类号：R687.3 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.08.003

文章编号：1006-1959（2018）08-0010-04

Selection of Treatment Strategy for Early Femoral Head Necrosis in Young and Middle-aged Population

PAN Feng-yu，ZHANG Yong-quan

（Department of Joint Surgical，107th PLA Hospital，Yantai 264002，Shandong，China）

Abstract：Femoral head necrosis is a highly disabling disease that often occurs in young and middle-aged people.In the early stage before the collapse of the femoral head，the hip preservation surgery is usually used，but there are many ways to treat the hip preservation.How to choose the appropriate treatment is a difficult problem that the doctor must face."Blood circulation disorder"is the common pathological characteristic of femoral head necrosis.The starting point of hip preservation surgery is to solve this problem.The ideal operation method needs to achieve the following four treatment objectives：removing dead bone and fibrous granulation tissue，improving femoral head blood circulation，providing structural support，promoting new bone formation.Under current technical conditions，bone transplantation with debridement and blood delivery can achieve these four treatment goals simultaneously and become an ideal way to treat early femoral head necrosis in young and middle-aged people.Among them，iliac bone transplantation with vascular pedicle was the best.

Key words：Osteonecrosis of femoral head；Young adults；Hip preservation therapy；Iliac bone graft with pedicle

股骨头坏死（osteonecrosis of the femoral head，ONFH）属于缺血性骨坏死，是指股骨头血供中断或受损，引起骨细胞、骨髓造血细胞和脂肪细胞（即骨的活性成分）死亡及修复的病理过程，疾病进展将导致关节软骨的破坏、股骨头塌陷、髋关节功能丧失。股骨头坏死的致残率较高，是骨科领域的难治性疾病之一[1]。由于目前早期股骨头坏死的治疗效果并不十分理想，许多患者最终进展至股骨头塌陷的晚期阶段[2]，不得不接受髋关节置换手术，给患者带来巨大的身心痛苦和经济负担。近年来，青壮年发生股骨头缺血坏死有逐渐增多的趋势。因此，针对该类患者人群，如何在股骨头坏死的早期阶段选择恰当的治疗方案，这是一个值得临床医生深入探讨的课题。……