股骨头坏死保髋治疗：从病理机制到临床决策的综合进展

Hip-Preserving Treatment for Avascular Necrosis of the Femoral Head: Comprehensive Progress from Pathological Mechanisms to Clinical Decision-Making

摘要: 股骨头坏死(ONFH)是一种因血供中断导致骨细胞死亡及关节塌陷的致残性疾病，对年轻及活动量大患者的关节功能和生活质量构成严重威胁。保髋治疗旨在延缓疾病进展、避免或推迟全髋关节置换，具有极其重要的临床价值。本文旨在系统梳理保髋治疗的最新进展与挑战。综述首先深入探讨ONFH的病理生理学机制，特别是与治疗决策相关的关键生物学基础。其次，全面评述当前主流的保髋治疗策略，涵盖非手术治疗、髓芯减压术及其增强技术、各类植骨术以及生物物理疗法。接着，重点分析影响保髋疗效的核心预后因素，如坏死分期、范围、位置及患者个体特征。然后，审视生物制剂与新兴技术在保髋领域的应用前景。最后，讨论当前临床实践中的争议与未来研究方向，以期为推动个体化、精准化的保髋治疗决策提供循证依据。

Abstract: Osteonecrosis of the femoral head (ONFH) is a disabling disease that causes bone cell death and joint collapse due to interruption of blood supply, posing a serious threat to the joint function and quality of life of young and active patients. Hip preservation therapy aims to delay disease progression, avoid or postpone total hip arthroplasty, and has extremely important clinical value. This article aims to systematically summarize the latest progress and challenges in hip preservation therapy. The review first delves into the pathophysiological mechanisms of ONFH, especially the key biological underpinnings relevant to treatment decision-making. Second, it comprehensively evaluates current mainstream hip preservation treatment strategies, including non-surgical treatment, core decompression and its enhanced techniques, various bone grafting procedures, and biophysical therapies. Next, it focuses on analyzing the core prognostic factors affecting the efficacy of hip preservation, such as necrosis stage, extent, location, and patient individual characteristics. Then, it examines the application prospects of biological agents and emerging technologies in the field of hip preservation. Finally, it discusses the current controversies in clinical practice and future research directions, with the aim of providing evidence-based support for promoting individualized and precision hip preservation treatment decision-making.