股骨頭壞死研究所擬對早中期未行手術(shù)治療的股骨頭壞死患者提供免費(fèi)檢查。包括：髖關(guān)節(jié)3.0T磁共振，骨密度，骨盆正位片，雙髖蛙位片等，數(shù)量有限，請有需要的朋友提前預(yù)約。專家門診時(shí)間：每周一洛陽東花壇院區(qū)門診305診室！

股骨頭壞死保髖/保頭治療：股骨近端截骨術(shù)治療股骨頭缺血性壞死作者：ThorstenMSeyler,DavidRMarker,SlifDUlrich,TobiasFatscher,MichaelAMont作者單位:DepartmentforOrthopedicSurgery,UniversityHospitalBerne,Freiburgstra?e8,3010,Bern,Switzerland.christianesylvia.leibold@insel.ch.譯者：陶可（北京大學(xué)人民醫(yī)院骨關(guān)節(jié)科）摘要目的：通過將股骨頭壞死區(qū)轉(zhuǎn)移出主要負(fù)重區(qū)，將健康骨轉(zhuǎn)移至負(fù)重區(qū)，從而延緩股骨頭壞死的進(jìn)展，促進(jìn)壞死骨愈合。適應(yīng)癥：相對年輕的患者（年齡＜50歲）的局灶性股骨頭骨壞死，無晚期退行性指征（T?nnis等級≤1）。禁忌癥：X線顯示髖關(guān)節(jié)退變（＞T?nnis1級）；廣泛的缺血性壞死（Kerboul角＞240°）；晚期病變（≥骨循環(huán)研究協(xié)會(huì)[ARCO]分分期3b期）。手術(shù)技術(shù)：通過進(jìn)行髖關(guān)節(jié)脫位手術(shù)，可以完全暴露髖關(guān)節(jié)。股骨內(nèi)翻截骨術(shù)用于將股骨頭的壞死病變轉(zhuǎn)出中央承重區(qū)并更靠近內(nèi)側(cè)。使用角穩(wěn)定螺釘或鋼板進(jìn)行截骨處固定。通過活板門手術(shù)，可以從大轉(zhuǎn)子直接清創(chuàng)（股骨頭壞死骨）和自體骨移植。盡可能保留軟骨瓣或用自體基質(zhì)誘導(dǎo)軟骨形成(AMIC)代替進(jìn)行修復(fù)。術(shù)后管理：住院期間，術(shù)后立即進(jìn)行被動(dòng)運(yùn)動(dòng)鍛煉，以防止髖關(guān)節(jié)囊粘連。手術(shù)后，患者需要借助拐杖進(jìn)行至少8周的15公斤的部分負(fù)重活動(dòng)。限制用力外展、內(nèi)收及屈曲90°以上，以保護(hù)大轉(zhuǎn)子截骨（避免截骨處不愈合風(fēng)險(xiǎn)）。在8周隨訪時(shí)影像學(xué)確認(rèn)截骨處愈合后，允許逐步恢復(fù)完全負(fù)重并開始外展肌訓(xùn)練。結(jié)果：9例（10髖）股骨頭壞死患者采用髖關(guān)節(jié)外科脫位內(nèi)翻截骨術(shù)治療。6髖采用自體植骨，4髖采用順行鉆孔（髓心減壓）。4例縫合軟骨損傷，2例需要AMIC治療。手術(shù)時(shí)的平均年齡為29±9歲(20-49歲)，所有患者的平均隨訪時(shí)間為3±2年(1-7年)。1例髖關(guān)節(jié)病情進(jìn)展，隨后進(jìn)行全髖關(guān)節(jié)置換術(shù)。其他9個(gè)髖關(guān)節(jié)沒有出現(xiàn)股骨頭壞死進(jìn)展，臨床結(jié)果也有所改善。并發(fā)癥為股骨截骨處假關(guān)節(jié)和大轉(zhuǎn)子假關(guān)節(jié)形成。關(guān)鍵詞：髖關(guān)節(jié)脫位；骨壞死；截骨術(shù)；活板門手術(shù)；負(fù)重手術(shù)原則和目的股骨近端截骨術(shù)治療股骨頭壞死(ONFH)的目的是將壞死區(qū)域移出負(fù)重區(qū)域，從而延緩骨壞死進(jìn)展甚至愈合。治療股骨頭壞死(ONFH)的股骨截骨術(shù)可分為成角(內(nèi)翻/外翻/屈伸)截骨術(shù)和旋轉(zhuǎn)截骨術(shù)。在旋轉(zhuǎn)經(jīng)轉(zhuǎn)子截骨術(shù)中，股骨頭頸骨折塊的壞死區(qū)繞股骨頸軸向前或向后旋轉(zhuǎn)，以移出壞死區(qū)。通過內(nèi)翻截骨術(shù)，壞死病變向內(nèi)側(cè)移動(dòng)，而股骨頭的外側(cè)（通常是非壞死部分）移動(dòng)至負(fù)重區(qū)域。根據(jù)矢狀位磁共振成像(MRI)序列上壞死的定位，可以執(zhí)行額外的屈曲或伸展矯正。對于所有手術(shù)，準(zhǔn)確了解股骨近端的血管解剖對于避免醫(yī)源性壞死至關(guān)重要[11,15]。優(yōu)點(diǎn)(股骨近端截骨術(shù)治療股骨頭壞死)?髖關(guān)節(jié)外科脫位[4]可以完全接觸到髖臼和股骨頭。?壞死區(qū)域的直接治療可以通過刮除（壞死骨）術(shù)、骨移植和軟骨損傷治療來進(jìn)行。?可以進(jìn)行偏心距矯正、盂唇治療或股骨扭轉(zhuǎn)角矯正等同期手術(shù)[21]。?內(nèi)翻或屈曲截骨術(shù)可減少壞死病變處的負(fù)荷力并幫助骨骼愈合。缺點(diǎn)(股骨近端截骨術(shù)治療股骨頭壞死)?至少8周的限制性負(fù)重。?手術(shù)技術(shù)要求高。?由于內(nèi)翻截骨術(shù)導(dǎo)致的杠桿臂、肌肉張力和腿長度縮短導(dǎo)致的髖部解剖學(xué)變化可能導(dǎo)致跛行。?轉(zhuǎn)子螺釘或骨板可能需要二次手術(shù)拆除。適應(yīng)癥(股骨近端截骨術(shù)治療股骨頭壞死)?股骨頭局限性骨壞死。?無晚期退行性征象（常規(guī)X線片中T?nnis等級≤1）?相對年輕的患者（年齡＜50歲）禁忌癥(股骨近端截骨術(shù)治療股骨頭壞死)?X線顯示髖關(guān)節(jié)明顯退化（＞T?nnis1級）。?廣泛性股骨頭骨壞死（Kerboul≥240°）?晚期病變（骨循環(huán)研究協(xié)會(huì)[ARCO]分期≥3b期）。?老年患者（年齡≥50歲）。患者信息一般手術(shù)風(fēng)險(xiǎn)（血栓形成；肺栓塞；過敏反應(yīng)；術(shù)中定位導(dǎo)致的皮膚、肌肉和神經(jīng)損傷；皮膚神經(jīng)損傷伴麻木/感覺遲鈍；出血過多需要血液制品輸注；傷口愈合延遲和感染）特定風(fēng)險(xiǎn)(股骨近端截骨術(shù)治療股骨頭壞死)?盡管進(jìn)行了手術(shù)，但壞死和骨關(guān)節(jié)炎仍在惡化?截骨術(shù)或大轉(zhuǎn)子的延遲愈合和假關(guān)節(jié)形成?雙側(cè)腿長度差異?異位骨化術(shù)前檢查?充分了解患者的病史（例如，正在進(jìn)行的類固醇治療、化療、酗酒）對于評估是否可以選擇保髖手術(shù)至關(guān)重要?標(biāo)準(zhǔn)化的X線成像，包括骨盆前后位射線照相和軸向視圖，用于使用模板進(jìn)行規(guī)劃?髖關(guān)節(jié)磁共振關(guān)節(jié)造影，最好通過關(guān)節(jié)內(nèi)注射造影劑和腿部牽引來評估壞死的大小和位置以及髖關(guān)節(jié)內(nèi)損傷[16]?軸位成像（計(jì)算機(jī)斷層掃描[CT]或MRI）用于評估股骨扭轉(zhuǎn)角，以對扭轉(zhuǎn)進(jìn)行可能的額外矯正?股骨截骨方向和程度的術(shù)前模板；內(nèi)翻截骨術(shù)將位于內(nèi)側(cè)的病灶更靠內(nèi)側(cè)，將未受影響的外側(cè)部分轉(zhuǎn)移到承重區(qū)，股骨屈曲截骨術(shù)將位于前方的病灶更靠前，將未受影響的后部轉(zhuǎn)移到承重區(qū)；可以結(jié)合內(nèi)翻和屈曲截骨術(shù)；通常在任何方向上執(zhí)行不超過20°的校正工具用于股骨近端的鎖定加壓接骨板（兒童髖接骨板；DePuySynthes，Zuchwil，Switzerland）或用于成人的角形刀片接骨板（DePuySynthes）用于軟骨治療的可選纖維蛋白膠（Tissucol；Baxter，Warsaw，Poland）可選的自體基質(zhì)誘導(dǎo)軟骨形成(AMIC)，具有I/III型膠原基質(zhì)（Chondro-Gide；GeistlichPharma，Wolhusen，Switzerland）麻醉和體位?全身麻醉，肌肉組織完全放松?嚴(yán)格的側(cè)臥位?用前后方支撐穩(wěn)定患者?將未受累的小腿放置在隧道枕墊中以避免受壓，并為受累的下肢在水平位置安排一個(gè)平面?消毒和無菌手術(shù)單包括整個(gè)下肢直至胸部；大轉(zhuǎn)子應(yīng)該可以自由觸及?用于術(shù)中定位和監(jiān)測截骨術(shù)、角度校正和鋼板螺釘放置的X線透視檢查?單次靜脈注射抗生素預(yù)防（頭孢呋辛）Fig.1Astraightlateralskinincisionof15–20cmismade,centeredoverthegreatertrochanterwiththepatientinthelateraldecubitusposition.圖1一個(gè)15-20cm的直的外側(cè)皮膚切口，以大轉(zhuǎn)子為中心，患者處于側(cè)臥位。Fig.2Asurgicalhipdislocationisanintermuscularandinternervalapproach.Afterincisionofthetractus,thesuperficialintervalbetweenthegluteusmaximusandgluteusmedius(Gibsoninterval)isdeveloped.Thedeepintervalisbetweenthepiriformisandthegluteusminimusmuscleandbestdevelopedwiththehipinextensionandinternalrotation圖2髖關(guān)節(jié)外科脫位是一種肌間和神經(jīng)間入路。切開髂脛束后，形成臀大肌和臀中肌之間的淺層間隙（Gibson間隙）。深層間隔位于梨狀肌和臀小肌之間，在髖關(guān)節(jié)伸展和內(nèi)旋時(shí)顯露最好。Fig.3Typically,asteppedtrochantericosteotomyisperformedtominimizetheriskoftrochantericpseudarthrosisafterrefixation.Alternatively,aflatosteotomycanbeperformedwhenthegreatertrochanterhastobedistalized,ifthevarusosteotomywouldresultinahighridingtrochanter[1].Theosteotomystartsattheposterosuperiortipofthegreatertrochanterandends10–15mmdistaltothelateraltubercle.Proximally,theosteotomyshouldendjustanteriortothemostposteriorinsertionofthegluteusmediusleavingtheshortexternalrotatorsattachedtotheproximalfemur.Thetrochantericfragmentismobilizedtogetherwiththevastuslateralis,gluteusminimus,andmediusmuscleventrallyandthecapsuleisexposed.圖3通常，進(jìn)行階梯式轉(zhuǎn)子截骨術(shù)以最大限度地降低再固定后大轉(zhuǎn)子假關(guān)節(jié)形成的風(fēng)險(xiǎn)?；蛘撸绻麅?nèi)翻截骨術(shù)會(huì)導(dǎo)致轉(zhuǎn)子向高位滑動(dòng)，則當(dāng)必須將大轉(zhuǎn)子遠(yuǎn)移時(shí)，可以進(jìn)行水平截骨術(shù)[1]。截骨術(shù)從大轉(zhuǎn)子的后上頂端開始，到外側(cè)結(jié)節(jié)遠(yuǎn)端10-15mm處結(jié)束。在近端，截骨術(shù)應(yīng)該在臀中肌最后止點(diǎn)之前結(jié)束，保留短外旋肌群附著在股骨近端上。轉(zhuǎn)子截骨塊與股外側(cè)肌、臀小肌和臀中肌一起向腹側(cè)牽拉，并暴露髖關(guān)節(jié)囊。Fig.4Thevascularanatomyoftheproximalfemurhastoberespectedwhenperforminganosteotomy.Themainnutrientvesselofthefemoralheadisthemedialbranchofthemedialfemoralcircumflexartery(MCFA)圖4進(jìn)行截骨術(shù)時(shí)必須注意股骨近端的血管解剖結(jié)構(gòu)。股骨頭的主要營養(yǎng)血管是旋股內(nèi)側(cè)動(dòng)脈（MCFA）的內(nèi)側(cè)支。Fig.5Thecapsuleisincisedinaz-shapedmannerwithoutviolatingthelabrum.Theligamentumteresiscutinasubluxedpositiontoallowforfulldislocationofthefemoralhead圖5在不侵犯髖關(guān)節(jié)盂唇的情況下，以z字形方式切開髖關(guān)節(jié)囊。股骨頭凹韌帶在髖關(guān)節(jié)半脫位時(shí)切斷以允許股骨頭完全脫位。Fig.6aTheacetabulumandfemoralheadareinspected.Typically,thecartilagecoveringtheareaofthefemoralheadnecrosisisfrayed,softened,ordetachedfromthesubchondralbone.Thecartilageiselevatedfromthesubchondralbonetoaccessthenecroticbone.Ifnotdelaminated,anincisionofthecartilageattheborderofthenecroticareaismade.Withahigh-speedburr,curettageofthenecroticboneisperformed.Boneisremoveduntilbleedingcancellousboneisfound.Throughthetrochantericosteotomy,harvestingofautologouscancellousboneofthetrochantermajorisperformed.bThelesionsarefilledwithimpactionbonegrafting[19].Whereverpossible,cartilageispreservedbygluingbackthepreviouslydetachedcartilageusingfibringlueandsuturingofthecartilageboarderwithresorbablemonofilamentsutures.Withaconcomitantfemoralcartilagedefectpresent,anautologousmatrix-inducedchondrogenesis(AMIC)isperformed.AMICisusedforfullcartilagedefects,whicharethencoveredwithatypeI/IIIcollagenmatrix(Novocart),gluedtothebonewithfibringlue,andattachedtothestablecartilagewithsutures圖6a檢查了髖臼和股骨頭。通常，覆蓋股骨頭壞死區(qū)域的軟骨磨損、軟化或與軟骨下骨分離。軟骨從軟骨下骨升高以接近壞死骨。如果沒有分層，則在壞死區(qū)域的邊界處切開軟骨。使用高速磨刀刮除壞死骨，直到發(fā)現(xiàn)出血的松質(zhì)骨。通過轉(zhuǎn)子截骨術(shù)，采集大轉(zhuǎn)子的自體松質(zhì)骨。b病變充滿嵌塞移植骨[19]。在可能的情況下，通過使用纖維蛋白膠粘回先前分離的軟骨并用可吸收的單股縫合線縫合以保留軟骨。由于存在伴隨的股骨軟骨缺損，因此進(jìn)行了自體基質(zhì)誘導(dǎo)軟骨形成(AMIC)。AMIC用于全軟骨缺損，然后用I/III型膠原基質(zhì)（Novocart）覆蓋，用纖維蛋白膠粘在骨質(zhì)上，并用縫線固定在穩(wěn)定的軟骨上。Fig.7Thefirstguidewireisplacedextra-articularlyinlinewiththeaxisofthefemoralneck.ItindicatesthefemoralantetorsionandtheheightoftheentrypointofthepositioningKirschnerwireinthesagittalplane.Thecalculatedcorrectionanglehastobeadjustedontheaimingblock.Theaimingblockconsistsofaguideproximallyandawingdistally;thewingmustbeplacedparalleltotheshaftofthefemur.Ifadditionalflexionorextensioncorrectionisneeded,thewingoftheaimingblockcanbeplacedposteriororanterioronthediaphysis.ThepositioningKirschnerwireistheninsertedthroughtheaimingblockandplacedinthecenterofthefemoralneck.圖7第一根導(dǎo)針在關(guān)節(jié)外與股骨頸的軸線對齊。它表示股骨前傾角和矢狀面上定位克氏針進(jìn)入點(diǎn)的高度。必須在瞄準(zhǔn)塊上調(diào)整計(jì)算出的校正角度。瞄準(zhǔn)塊由近端的導(dǎo)向器和遠(yuǎn)端的翼部組成；翼部必須平行于股骨干放置。如果需要額外的屈曲或伸展矯正，瞄準(zhǔn)塊的翼部可以放置在骨干的后部或前部。然后將定位克氏針穿過瞄準(zhǔn)塊插入并放置在股骨頸的中心。Fig.8Twomoreguidewiresareinsertedthroughtheholesprovidedintheaimingblock;theywillserveasguidewiresforthecannulatedfemoralneckscrews.Tocontroltherotation,theanteriorcortexismarkedwithtwoparallelwires.Theosteotomyistypicallyperformedattheintertrochantericlevelperpendiculartotheshaftunderconstantirrigation.Avarizationof15–20°isusuallysufficient.Theplateisattachedtotheproximalfragmentwiththreeangularstableandcannulatedscrews;typically,twoofthemareplacedinthefemoralneck,oneinthecalcarregion.圖8通過瞄準(zhǔn)塊上的孔插入另外兩根導(dǎo)針；它們將用作空心股骨頸螺釘?shù)膶?dǎo)針。為了控制旋轉(zhuǎn)，前皮質(zhì)標(biāo)有兩條平行線。截骨術(shù)通常在不斷沖洗的情況下在垂直于軸的轉(zhuǎn)子間水平進(jìn)行。15–20°的變化通常就足夠了。用三個(gè)角度穩(wěn)定的空心螺釘將骨板固定在近端骨折塊上；通常，其中兩個(gè)放置在股骨頸，一個(gè)在股骨距區(qū)域。Fig.9Animplantwithoffsetcanbeusedtopreventadditionallateralizationofthediaphysealfragment.Theplateisthenfixedtothediaphysealfragmentwitheitherlockingheadorcorticalscrews.圖9帶偏心距的內(nèi)固定物可用于防止骨干碎片的額外外側(cè)移位。然后用鎖定頭或皮質(zhì)螺釘將鋼板固定到骨干骨折塊上。Fig.10Fixationofthetrochantericfragmentisperformedwith3.5-mmcorticalscrews,optionallyinadistalizedpositiontoavoidahighridingtrochanter.圖10使用3.5毫米皮質(zhì)螺釘固定轉(zhuǎn)子骨碎片，可選擇在遠(yuǎn)端位置以避免大轉(zhuǎn)子高位。Fig.11Exemplarycasewithre-osteosynthesisofapseudarthrosis.aPreoperativeimagewithosteonecrosis;bshortlyaftersurgeryfollowingvarizationandtrapdoorprocedure;c8monthspostoperativelywithpseudarthrosisofthefemoralosteotomy;d4-yearpostoperativeimageafterre-osteosynthesisoftheosteotomy,maintainingsphericityofthefemoralhead.圖11假關(guān)節(jié)再骨合成的示例性病例。a骨壞死的術(shù)前圖像；b內(nèi)翻截骨和活板門手術(shù)后不久；c術(shù)后8個(gè)月，股骨截骨假關(guān)節(jié)形成；d截骨術(shù)再骨化后4年的術(shù)后圖像，保持股骨頭的球形度。Table2Comparisonwithothercentersusingfemoralosteotomiesfornontraumaticosteonecrosis表2與使用股骨截骨術(shù)治療非創(chuàng)傷性骨壞死的其他中心的比較FemoralosteotomiesforthetreatmentofavascularnecrosisofthefemoralheadObjective:Unloadingoftheareaofnecrosisoutoftheweight-bearingregionbyshiftinghealthyboneinthemainweight-bearingarea,whichmaydelaytheprogressionofthenecrosisandenablehealing.Indications:Circumscribedosteonecrosisofthefemoralheadwithoutadvanceddegenerativesigns(T?nnisgrade≤1)intherelativelyyoungpatient(age＜50years).Contraindications:Radiographicjointdegeneration(＞T?nnisgrade1);extensiveavascularnecrosis(Kerboulangle＞240°);advancedlesions(≥AssociationResearchCirculationOsseous[ARCO]classification3b).Surgicaltechnique:Byperformingasurgicalhipdislocation,fullaccesstothehipjointisgained.Afemoralvarusosteotomyisusedtoturnthenecroticlesionofthefemoralheadoutofthecentralweight-bearingareaandmoremedially.Osteosynthesisisperformedwithanangularstablescreworabladeplate.Viaatrapdoorprocedure,directdebridementandautologousbonegraftingfromthetrochantermajorispossible.Thecartilageflapispreservedwheneverpossibleorsupplantedbyanautologousmatrix-inducedchondrogenesis(AMIC).Postoperativemanagement:Apassivemotiondeviceisinstalledduringhospitalstaybeginningimmediatelyaftersurgerytopreventcapsularadhesions.Aftersurgery,patientsaremobilizedwithpartialweight-bearingof15kgwiththeuseofcrutchesforatleast8weeks.Forcedabductionandadductionaswellasflexionofmorethan90°arerestrictedtoprotectthetrochantericosteotomy.Afterradiographicconfirmationofhealingatthe8?weekfollow-up,stepwisereturntofullweight-bearingisallowedandabductortrainingisinitiated.Results:Ninepatients(10hips)withosteonecrosisofthefemoralheadweretreatedwithsurgicalhipdislocationandvarusosteotomy.Sixhipsweretreatedwithautologousbonegrafting,fourhipswithantegradedrilling.Chondrallesionsweresuturedinfourcases,whereastwocasesneededanAMICtreatment.Themeanageatoperationwas29±9years(20-49),andthemeanfollow-uptimeforallpatientswas3±2years(1-7).Conversiontoatotalhipprosthesiswasrequiredforonehipwithprogressingarthrosis.Theotherninehipsshowednoprogressionofnecrosisandanimprovedclinicaloutcome.Complicationswerepseudarthrosisofthefemoralosteotomyandpseudarthrosisofthegreatertrochanter.Keywords:Hipdislocation;Osteonecrosis;Osteotomy;Trapdoorprocedure;Weight-bearing.SurgicalprincipleandobjectiveTheaimoffemoralosteotomiesinthetreatmentofONFHistomovetheareaofnecrosisoutoftheweight-bearingregion,whichleadstodelayedprogressionorevenhealingofthenecrosis.FemoralosteotomiesinthetreatmentofONFHcanbedividedintoangularandrotationalosteotomies.Witharotationaltranstrochantericosteotomy,thenecroticzoneofthehead-neckfragmentisrotatedanteriororposterioraroundtheneckaxistounloadthenecroticzone.Withavarusangularosteotomy,thenecroticlesionisshiftedmediallyandthelateral,typicallynon-necroticpartofthefemoralheadisdisplacedintheareaofweight-loading.Additionalflexionorextensioncorrectioncanbeperformed,dependingonthelocalizationofnecrosisonsagittalmagneticresonanceimaging(MRI)sequences.Forallprocedures,preciseknowledgeofthevascularanatomyoftheproximalfemurisessentialtoavoidiatrogenicnecrosis[11,15].Advantages·Surgicalhipdislocation[4]providesfullaccesstotheacetabulumandthefemoralhead.·Directtreatmentofthenecroticareacanbeperformedwithcurettage,bonegrafting,andtreatmentofcartilagelesions.·Concomitantproceduressuchasoffsetcorrection,labraltreatment,orcorrectionoffemoraltorsioncanbeperformed[21].·Avarusorflexionosteotomydecreasestheloadingforceonthenecroticlesionandhelpsthebonetoheal.Disadvantages·Minimum8weeksoflimitedweightbearing.·Technicallydemandingsurgicaltechnique.·Changeinhipanatomywithchangesinleverarm,musculartension,andleglengthshorteningduetovarusosteotomymayleadtolimping.·Trochantericscrewsorplatemayrequiresecondaryhardwareremoval.Indications·Circumscribedosteonecrosisofthefemoralhead.·Noadvanceddegenerativesigns(T?nnisgrade≤1intheconventionalradiograph)·Relativelyyoungpatient(age＜50years)Contraindications·Advancedradiographicjointdegeneration(＞T?nnisgrade1).·Extensiveosteonecrosis(Kerboul≥240°)Advancedlesions(≥grade3bAssociationResearchCirculationOsseous[ARCO]classification).·Olderpatients(age≥50years).PatientinformationGeneralsurgicalrisks(thrombosis;lungembolism;allergicreactions;injuriesofskin,muscle,andnervesduetointraoperativepositioning;injuryofcutaneousnerveswithnumbness/dysesthesia;excessivebleedingrequiringbloodproducts;delayedwoundhealingandinfection)Specificrisksofthisprocedure:·Progressionofnecrosisandosteoarthritisinspiteofoperation·Delayedunionandpseudarthrosisoftheosteotomyorgreatertrochanter·Leglengthdiscrepancy·HeterotopicossificationPreoperativework-up·Goodknowledgeofthepatient’shistory(e.g.,ongoingsteroidtherapy,chemotherapy,alcoholabuse)isessentialtoevaluatewhetherahippreservingoperationisanoption.·Standardizedradiographicimagingincludinganteroposteriorpelvicradiographandaxialviewforplanningwithtemplates.·Magneticresonancearthrographyofthehip,preferablywithintraarticularcontrastagentinjectionandlegtractionforevaluationofsizeandlocationofthenecrosisandtheintraarticulardamage[16].·Axialimaging(computedtomography[CT]orMRI)forevaluationoffemoraltorsion,forpossibleadditionalcorrectionoftorsion.·Preoperativetemplatingforthedirectionanddegreeoffemurosteotomy;varusosteotomyshiftsamediallylocatedlesionmoremedialandthenon-affectedlateralpartintotheweight-bearingzone,femoralflexionosteotomyshiftsananteriorlylocatedlesionmoreanteriorandthenon-affectedposteriorpartintotheweightbearingzone;bothvarusandflexionosteotomiescanbecombined;nomorethan20°ofcorrectioninanydirectionisusuallyperformed.InstrumentsLockingcompressionplateforproximalfemur(pediatrichipplate;DePuySynthes,Zuchwil,Switzerland)orangledbladeplateforadults(DePuySynthes).Optionalfibringlue(Tissucol;Baxter,Warsaw,Poland)forcartilagetreatment.Optionalautologousmatrix-inducedchondrogenesis(AMIC)withtypeI/IIIcollagenmatrix(Chondro-Gide;GeistlichPharma,Wolhusen,Switzerland).Anesthesiaandpositioning·Generalanesthesiawithfullrelaxationofthemusculature.·Strictlateraldecubitusposition.·Stabilizationofpatientwithtwosidesupports.·Placementoftheuninvolvedlowerleginatunnelbolstertoavoidpressureandarrangementofaflatsurfaceinahorizontalpositionfortheinvolvedlowerlimb.·Disinfectionandsteriledrapesincludetheentirelowerextremityuptothethorax;thegreattrochantershouldbefreelypalpable.·Fluoroscopyforintraoperativeorientationandmonitoringoftheosteotomy,angularcorrections,andplacementofhardware.·Single-shotintravenousantibioticprophylaxis(cefuroxime).文獻(xiàn)出處：ChristianeSylviaLeibold,FlorianSchmaranzer,Klaus-ArnoSiebenrock,SimonDamianSteppacher.Femoralosteotomiesforthetreatmentofavascularnecrosisofthefemoralhead.Review,OperOrthopTraumatol.2020Apr;32(2):116-126.doi:10.1007/s00064-019-00642-x.Epub2019Nov29.

股骨頭壞死患者朋友們在日常生活中，這些動(dòng)作就不要做了。第一個(gè)，就是蹦跳，人在做蹦跳時(shí)髖部會(huì)受到很大的沖擊，容易導(dǎo)致股骨頭塌陷。其他類似增加髖部負(fù)擔(dān)的動(dòng)作比如扛重東西、提重物這些動(dòng)作也要避免。第二就是盤腿，盤腿動(dòng)作對髖關(guān)節(jié)的關(guān)節(jié)囊會(huì)形成拉伸，可能影響到股骨頭的血運(yùn)，這些個(gè)動(dòng)作也是要盡量避免。第三點(diǎn)就是避免久坐久站。我們鼓勵(lì)進(jìn)行康復(fù)鍛煉，預(yù)防肌肉萎縮，但是鍛煉的時(shí)候也要遵循正確的原則，盡量采用免負(fù)重的鍛煉方式，比如在墊子上進(jìn)行髖部活動(dòng)，蹬自行車，游泳等。嚴(yán)禁進(jìn)行激烈的運(yùn)動(dòng)，避免外傷加重病情。你還想了解股骨頭的哪些方面可以評論區(qū)發(fā)給我。

股骨頭壞死，很多人叫骨科“不死的癌癥”，是因?yàn)楣晒穷^壞死到目前為止，仍然是骨科當(dāng)中一種非常難治的疾病。但是無論中醫(yī)或者西醫(yī)，目前都認(rèn)為股骨頭壞死的早期和中期進(jìn)行保髖治療是非常重要的。對于早中期的患者，我們擅長用中醫(yī)藥的方法，配合康復(fù)鍛煉，可以改善患者的疼痛，減輕髖關(guān)節(jié)活動(dòng)障礙，通過治療有很多患者并不需要進(jìn)行關(guān)節(jié)置換。所以從這個(gè)角度來說，股骨頭壞死還是可以治療的。