股骨头坏死(ONFH)是骨科临床中常见且难治性的疾病。全球ONFH患者的数量每年都在增加。仅在中国,估计就有812万非创伤性骨坏死患者。非创伤性骨坏死的治疗一直是骨科医师的临床挑战。为了进一步规范ONFH的诊断和治疗,这些指南不仅提供了基本的诊断,治疗,以及ONFH的评估系统,以及许多方面的专家建议和标准,包括流行病学,病因学,诊断标准,病理分期,预防和治疗选择,和术后康复。ONFH的病因目前可分为两大类:创伤性和非创伤性;然而,ONFH的具体病理机制尚不完全清楚。目前,CirculationOsseous协会制定的ONFH分期系统在临床实践中被广泛使用。根据骨内血液供应在不同阶段的变化,推荐相应的非手术和手术治疗,当存在可能的ONFH风险因素时,建议采取一定的预防措施避免骨坏死的发生。这些指南提供了骨坏死的简要分类标准和治疗方案。病因学的规范,综合考虑骨坏死不同阶段的治疗方案,髋关节功能,年龄,和患者的职业是诊断和制定治疗策略的重要步骤。
■流行病学的新进展,病因学,病理生理学,成像,本修订版更新了ONFH的诊断和治疗。该指南可供骨科专业人员和研究人员参考,并在临床指导下进行规范化诊疗管理,这有利于预防,ONFH的治疗和进一步研究,提高诊疗水平,使患者的症状得到良好控制,提高他们的生活质量。
Osteonecrosis of the femoral head (ONFH) is a common and refractory disease in orthopaedic clinics. The number of patients with ONFH is increasing worldwide every year. There are an estimated 8.12 million patients with nontraumatic osteonecrosis in China alone. Treatment of nontraumatic osteonecrosis has always been a clinical challenge for orthopaedic surgeons. To further standardize diagnosis and treatment of ONFH, these guidelines provide not only basic diagnosis, treatment, and evaluation systems for ONFH but also expert advice and standards in many aspects, including epidemiology, aetiology, diagnostic criteria, pathological staging, prevention and treatment options, and postoperative rehabilitation. The aetiological factors of ONFH can currently be divided into two major categories: traumatic and nontraumatic; however, the specific pathological mechanism of ONFH is not completely clear. Currently, the staging system of ONFH formulated by the Association Research Circulation Osseous is widely used in clinical practice. Based on the changes in the intraosseous blood supply at different stages, the corresponding nonsurgical and surgical treatments are recommended, and when there are risk factors for possible ONFH, certain preventive measures to avoid the occurrence of osteonecrosis are recommended. These guidelines provide brief classification criteria and treatment regimen for osteonecrosis. Specification of the aetiology, treatment plan based on comprehensive consideration of the different stages of osteonecrosis, hip function, age, and occupation of the patients are important steps in diagnosis and developing treatment strategies.
UNASSIGNED: New advances in the epidemiology, etiology, pathophysiology, imaging, diagnosis and treatment of ONFH have been renewed in this revision. This guideline can be used for reference by orthopedic professionals and researchers, and for standardized diagnosis and treatment management under the clinical guidance, which is conducive to the prevention, treatment and further research of ONFH, improving the diagnosis and treatment level, making patients\' symptoms under good control, and improving their quality of life.