摘要
随着激素在临床的大量应用,激素引起的股骨头坏死发生率也迅速升高.目前普遍认为激素引起的股骨头坏死是多种病理机制共同影响的结果.临床证据表明骨坏死的发生与激素的日均剂量及累计剂量高度相关,使用激素的患者并非都会出现股骨头坏死,可能与个人基因对激素的易感性有关.激素性股骨头坏死在病理形态学上分为三期:血运变化早期、中期及晚期.随着血运变化股骨头坏死范围逐渐增大,最终出现塌陷.股骨头坏死发现得越早,治疗方案的可选择性越多,预后往往也更好.规范激素的使用可以减少激素性股骨头坏死的发生,因此强调临床使用激素应慎重和规范.数字减影血管造影技术可以对早期股骨头坏死血运进行评估,根据评估情况选择药物或相应的术式进行治疗.激素性股骨头坏死通过早发现、早治疗可以取得较好的临床疗效.
With the heavily application of steroid in the clinic,the incidence of steroid-induced osteonecrosis of the femoral head is also rapidly increasing.It is generally believed that steroid-induced osteonecrosis of the femoral head is the result of a various of pathological mechanisms.Clinical evidence suggests that the occurrence of osteonecrosis is highly correlated with the daily mean dose and cumulative dose of steroid.Patients don't always have osteonecrosis of the femoral head which may be related to the susceptibility of individual genes to steroid.Steroid-induced osteonecrosis of the femoral head is divided into three stages by pathomorphological,indicating the early,middle and late stage of blood supply changes.With the change of blood supply,the range of osteonecrosis is gradually increasing,and eventually leads to collapses.The earlier the osteonecrosis is found,the more se・lective the treatments regimen are.The prognosis will be often better with early diagnosis.Regulating the use of steroid can reduce the occurrence of osteonecrosis.Thus,we emphasize that the use of steroid in clinical settings should be cautious and regulated.Digital subtraction angiography can be used to assess early osteonecrosis of the femoral head.According to the assessment of progression of disease,the drug or the corresponding surgical procedure will be selected.Steroid-induced osteonecrosis of the femoral head can achieve good clinical results through early detection and early treatments.
作者
赵德伟
Zhao Dewei(Department of Orthopaedics,Affiliated Zhongshan Hospital of Dalian University,Dalian 116001,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2019年第23期1421-1423,共3页
Chinese Journal of Orthopaedics
