股骨头前外侧柱与激素性股骨头坏死预后和保髋疗效的相关性研究
|
摘要
背景:激素性股骨头坏死仍然是骨科中尚未解决的问题之一,目前占所有股骨头坏死病例的一半左右,已经成为临床的常见病、多发病,具有较高的致残性。塌陷在股骨头坏死的病程中普遍存在,是疾病性质转归的关键,一旦发病,临床面临的关键问题是如何预测和防治塌陷。多种因素和塌陷相关,目前对塌陷及其相关问题尚缺乏全面准确的认识,临床上一方面缺乏简便可行的判断预后和评价保髋疗效的方法,另一方面也缺乏有效纠正塌陷、维持股骨头生物力学稳定的手段。根据髋臼的解剖分区、髋臼的应力分布特点、股骨头的应力分布特点和股骨头坏死区域的分布及塌陷特点,有感于正位分型的局限性,并受Ohzono和Sugano的启发,笔者发展完善了股骨头坏死的蛙位分型,并假设股骨头前外侧柱和激素性股骨头坏死预后与保髋疗效有密切相关性,正蛙位分型相结合能准确反映股骨头前外侧柱的状况,进而预测股骨头坏死的预后和评价保髋疗效。为了证实上述假设,笔者进行了相关的临床研究。
方法:2004年1月～2006年12月按照设计的诊断标准、纳入标准和排除标准募集在广州中医药大学第一附属医院髋关节病重点专科住院治疗的SONFH患者35例61髋,行中药辅助改良减压植骨内稳定术。对所有病例记录一般情况、基础疾病、激素使用情况、累及单双髋、ARCO分期、正蛙位分型;塌陷前的修正坏死范围指数;塌陷后的塌陷程度;骨髓水肿和关节积液分级;疼痛评分;再次塌陷的时间和程度;并进行疗效评价。将有关队列资料或数据输入SPSS13.0统计软件进行相关统计分析,Kaplan-Meier生存率分析以股骨头再次塌陷＞4mm为终点。
结果:1、本组病例的总有效率为77.05%,其中优占40.98%,良占14.75%,中占21.31%;总失败率为22.95%。蛙位分型C2与失败率呈显著的负相关,所有蛙位分型为C2的病例,其失败率均接近40%。排除所有蛙位C2型的病例,有效率为86.84%,优为52.63%,良为15.79%,中为18.42%,失败率为13.16%。
2、临床证候分型,本组病例中气滞血瘀型的占50%,没有发现单独的风寒湿痹型、痰湿型、气血虚弱型和肝肾不足型,常见气滞血瘀型兼后四种证型,其中兼痰湿型最多,占22.22%。
3、以再塌陷＞4mm为终点的Kaplan-Meier生存率分析显示,研究终止时(平均随访24.64个月)股骨头的生存率约为80%。
4、Spearman相关系数分析显示:(1)术前正蛙位分型与术后前外侧柱塌陷正相关;(2)术前ARCO分期与术后正位塌陷正相关,与蛙位塌陷无明显相关;(3)术前正位塌陷值与术后死骨修复、头臼和谐及关节稳定负相关,与术后软骨退变正相关;(4)术前蛙位塌陷值与术后死骨修复、头臼和谐及关节稳定负相关,与术后软骨退变正相关;(5)术前正位分型与术后软骨退变正相关,与术后死骨修复、关节稳定及头臼和谐负相关;(6)术前蛙位分型与术后软骨退变正相关,与术后死骨修复、头臼和谐及关节稳定负相关;(7)术前ARCO分期与术后软骨退变正相关,与术后死骨修复、头臼和谐负相关,与关节稳定无显著相关。
5、Logistic回归显示,与预后相关的危险指标为术前蛙位分型,术前蛙位分型越大则预后越差,术前蛙位分型每加重一个等级,为没有加重时,预后加重这个等级的14.96倍。。
6、逐步cox回归结果显示,在上述与生存时间相关的多因素中,危险指标为术前蛙位分型,术前蛙位分型越大,则股骨头生存时间越小,术前蛙位分型每增大一个等级则生存时间减少的可能性是无增大时的6.937倍。
结论:1、蛙位分型可以客观地反映股骨头前外侧柱坏死分布和塌陷情况,股骨头前外侧柱的完整性和稳定性与股骨头坏死预后和保髋疗效正相关,股骨头前外侧柱越完整越稳定,预后和保髋疗效就越好。正、蛙位分型相结合比单独正位分型能更全面地揭示股骨头前外侧柱的整体状况,减少观察盲区,具有更强的判断预后和评价疗效的能力,有利于中医辩证施治。
2、蛙位分型没有超过C1型,并且坏死区域为前外侧柱残留的正常骨质所包容,形成“包容性修复”,则预后良好;如果蛙位分型达C2型,并且坏死区域是开放的,没有前外侧柱正常骨质的保护,形成“开放性坏死,尤其是横贯股骨头的坏死区”,则预后不良。
3、围塌陷期的保髋手术要围绕着修复股骨头前外侧柱的完整性并尽可能维持其稳定性、防止发生严重的再塌陷这个核心进行。
4、改良减压植骨内稳定术只适用于蛙位分型C1型及以下者,不适用于蛙位分型达C2者。
5、髓芯减压的方向在尽可能保存残留的前外侧柱正常骨质的基础上,以股骨头前外侧的坏死中心区为宜;髓芯减压的深度要达软骨下骨板但不能穿出软骨面;松质骨打压的程度以股骨头基本恢复球形和头内新月征、台阶征和裂隙征基本消失为度,打压的质骨的厚度以5mm为宜;植入腓骨的条近端要修平,四周用1.5mm的克氏针钻孔;内稳定的空心加压螺钉要放在腓骨的正后方或者后内方。
Background.Steroid-induced Osteonecrosis of the Femoral Head(SONFH)is still one of unfathomed issues of Orthopaedics.Currently it has occupied assumably 50%of all Osteonecrosis of the Femoral Head(ONFH)cases,and has became a common disease with high incidence and risk of disabled.Collapse of femoral head is ubiquitous during the course of ONFH.It is the key of the conversion of the diseases.Once ONFH occurs,the clinical linchpin is how to predict and prevent collapse.Numerous factors are relative with the collapse of necrotic femoral head,presently cognition of collapse is still lack of entirety and accuracy.On the one hand,the clinical doctors are devoid of simple,convenient, feasible means to estimate prognosis and evaluate the Joint-Preserving Procedures curative effect.On the other hand,they are also short of effective measures to correct collapse and maintain the biomechanics stabilization of femoral head.According to acetabulum anatomic regions,acetabulum stress force distribution,femoral head stress force distribution,the characteristic of femoral head necrotic zone distribution and necrotic femoral head collapse,and the insufficiency of the anteroposterior x-ray view classification of osteonecrosis,illuming by Ohzono and Sugano,the author develops the frog leg view classification of osteonecrosis which was firstly established by LIU Shao Jun MD,and make a hypothesis that the anterolateral column of femoral head has a consanguineous relativity with prognosis and the Joint-Preserving Procedures curative effect of the SONFH.The author also assumes that the anteroposterior x-ray view classification combines with the frog leg view classification of osteonecrosis can reflect the conditions of the the anterolateral column of femoral head precisely,so that it can be used to estimate prognosis and evaluate the Joint-Preserving Procedures curative effect accurately.In order to testify the hypothesis above,the author carry out an clinic investigation.
Method.All patients who were hospitalized in Department of Arthrosis Surgery of the 1~(st) affiliated hospital of GuangZhou University of Traditional Chinese Medicine were recruited strictly in the light of diagnosis criteria,bringing into criteria and excluding criteria devised in the project between January 2004 and December 2006.Then finally we get 35 SONFH cases(61 hips)which fulfilled the criteria above.All patients' general information,basic disease,usage of Steroid,single or bilateral involved,ARCO Stage, Anteroposterior x-ray view and Flog Leg x-ray view Classification,Modified Index of necrotic extent before collapse,Collapse Degree after collapse,grade of Bone Marrow Edema and Hip Joint Fluid,grade of hip pain,the occure time and degree of post-operation collapse were all registered detailedly.After that evaluate curative effect and put data into the statistical software SPSS13.0 to analyse the results.The termination of Kaplan-Meier survivorship analysis is defined as collapse more than 4 millimeter after operation.
Findings.
1.Total effective rate of this head-preserving procedures was 77.05%,among these excellent rate was 40.98%,good rate was 14.75%,fair rate was 21.31%.General poor rate was 22.95%.There was a high negative correlation between Type C2 and failure,the poor rate of all the cases with Type C2 was near 40%.Excluding Type C2 the other cases' effective rate was 86.84%,excellent rate was 52.63%,good rate was 15.79%,fair rate was 18.42%,poor rate was 13.16%.
2.Traditional Chinese Medicine Syndrome-types Classification.Tagnancy of Qi and Blood Stasis type(TQBS)occupys 50%in all the studied cases.Wind Cold Damp impediment type,Phlegm-dampness type,Qi - deficiency and Phlegm - dampness type, Liver-Kiney deficiency type cannot be found alone.Type TQBS combined with the other four types frequently.Type TQBS mostly combined with Phlegm-dampness type,the combinative rate was 22.22%.
3.Kaplan-Meier survivorship curves demonstrated that the rate of survival of the necrotic femoral head was about 80%for a mean of 24.64 months(range,13-38 months)follow-up at the end of the study.
4.Spearman Rank Correlation Coefficient Assay:
(1)Positive correlation was found between the preoperative anteroposterior x-ray view classification,frog leg view classification and postoperative collapse degree of the anterolateral column of femoral head.
(2)Positive correlation was found between preoperative ARCO stages and postoperative collapse degree of anteroposterior x-ray view of femoral head.The correlation was not statistically significant between preoperative ARCO stages and postoperative collapse degree of frog leg view of femoral head.
(3)Positive correlation was found between preoperative anteroposterior x-ray view collapse degree and postoperative cartilage degeneration.Negative correlation between preoperative anteroposterior x-ray view collapse degree and postoperative necrotic zone restoration,harmony of femeral head and acetabulum,stabilization of hip joint were observed.(4)Positive correlation was found between preoperative frog leg x-ray view collapse degree and postoperative cartilage degeneration.Negative correlation between preoperative frog leg view x-ray collapse degree and postoperative necrotic zone restoration, harmony of femeral head and acetabulum,stabilization of hip joint were observed.
(5)Positive correlation was found between preoperative anteroposterior x-ray view Classification and postoperative cartilage degeneration.Negative correlation between preoperative anteroposterior x-ray view Classification and postoperative necrotic zone restoration,harmony of femeral head and acetabulum,stabilization of hip joint were observed.
(6)Positive correlation was found between preoperative frog leg x-ray view Classification and postoperative cartilage degeneration.Negative correlation between preoperative frog leg x-ray view Classification and postoperative necrotic zone restoration,harmony of femeral head and acetabulum,stabilization of hip joint were observed.
(7)Positive correlation was found between preoperative ARCO stages and postoperative cartilage degeneration.Negative correlation between preoperative ARCO stages and postoperative necrotic zone restoration,harmony of femeral head and acetabulum were observed.The correlation was not statistically significant between preoperative ARCO stages and postoperative stabilization of hip joint
5.Multiple logistic regression analysis showed that the dangerous prognostic index was preoperative frog leg x-ray view Classification.The higer the preoperative frog leg x-ray view Classification,the worse the prognosis was.The preoperative frog leg x-ray view Classification increased per grade leaded to the prognosis increased 14.96 folds compared with the prognosis which the frog leg x-ray view Classification did not increase.
6.COX regression analysis showed that the dangerous index was preoperative frog leg x-ray view Classification among those factors associated with the femoral head survivorship time.The higer the preoperative frog leg x-ray view Classification,the less the femoral head survivorship time was.The preoperative frog leg x-ray view Classification increased per grade leaded to the femoral head survivorship time decreased 6.937 folds compared with the time which the frog leg x-ray view Classification did not increase.
Interpretation.
1.Frog leg view x-ray classification can reflect the distribution of necrotic zone and collapse condition of anterolateral column of femoral head precisely.Positive correlation was found between integrality,stability of anterolateral column of femoral head and prognosis,Joint-Preserving Procedures curative effect of SONFH,the more integrated and stabile,the better the prognosis and curative effect were.The anteroposterior x-ray view classification combined with the frog leg x-ray view classification could reveal the total conditions of the the anterolateral column of femoral head more accurately compared with using the anteroposterior x-ray view classification alone.It also decreased the blind area of observation,was more effective to estimate prognosis and evaluate curative effect,it was propitious to treated SONFH with traditional medicine as well.
2.If the grade of frog leg x-ray view classification did not exceed Type C1,and necrotic zone was contained medially by remained normal bone of anterolateral column of femoral head,forming contained restoration,thus prognosis would be good.If the grade of frog leg x-ray view classification achieved Type C2 and necrotic region was open without protection of normal bone of anterolateral column,forming open restoration,especially generating traversing femoral head necrotic portion,thus the prognosis would be poor.
3.Joint-Preserving Procedures during peri-collapse period should aim at restoring the integrality and maintaining the stability of anterolateral column of femoral head,avoiding severe recollapse.
4.Modified core decompression combined with non-vascularized fibula graft,impaction bone grafting and stabilization inner femoral head with titanium hollow compression screw procedure was only applicable to frog leg x-ray view classification equal and less than type C1,it was inapplicable to type C2.
5.Orientation of core decompression shoud aim at the center of necrotic zone in femoral head anterolateral column preserving as much as possible normal bone of anterolateral femoral head portion.Depth of core decompression shoud achieve subchondral bone plate but never traverse through chondral.The degree of impaction bone grafting should be limited in recovering the shape of femoral head,eliminating the crescent sign,sidestep sign and crack sign in femoral head.Depth of impaction bone grafting should be limited in 5 millimeter.The peak of implanted fibula shuld be cut flat and drilled around its body with Kirschner wire(1.5 mm diameter).The titanium hollow compression screw stabilized femoral head inner should be located just behind or posterior and medial behind the fibula.
方法:2004年1月～2006年12月按照设计的诊断标准、纳入标准和排除标准募集在广州中医药大学第一附属医院髋关节病重点专科住院治疗的SONFH患者35例61髋,行中药辅助改良减压植骨内稳定术。对所有病例记录一般情况、基础疾病、激素使用情况、累及单双髋、ARCO分期、正蛙位分型;塌陷前的修正坏死范围指数;塌陷后的塌陷程度;骨髓水肿和关节积液分级;疼痛评分;再次塌陷的时间和程度;并进行疗效评价。将有关队列资料或数据输入SPSS13.0统计软件进行相关统计分析,Kaplan-Meier生存率分析以股骨头再次塌陷＞4mm为终点。
结果:1、本组病例的总有效率为77.05%,其中优占40.98%,良占14.75%,中占21.31%;总失败率为22.95%。蛙位分型C2与失败率呈显著的负相关,所有蛙位分型为C2的病例,其失败率均接近40%。排除所有蛙位C2型的病例,有效率为86.84%,优为52.63%,良为15.79%,中为18.42%,失败率为13.16%。
2、临床证候分型,本组病例中气滞血瘀型的占50%,没有发现单独的风寒湿痹型、痰湿型、气血虚弱型和肝肾不足型,常见气滞血瘀型兼后四种证型,其中兼痰湿型最多,占22.22%。
3、以再塌陷＞4mm为终点的Kaplan-Meier生存率分析显示,研究终止时(平均随访24.64个月)股骨头的生存率约为80%。
4、Spearman相关系数分析显示:(1)术前正蛙位分型与术后前外侧柱塌陷正相关;(2)术前ARCO分期与术后正位塌陷正相关,与蛙位塌陷无明显相关;(3)术前正位塌陷值与术后死骨修复、头臼和谐及关节稳定负相关,与术后软骨退变正相关;(4)术前蛙位塌陷值与术后死骨修复、头臼和谐及关节稳定负相关,与术后软骨退变正相关;(5)术前正位分型与术后软骨退变正相关,与术后死骨修复、关节稳定及头臼和谐负相关;(6)术前蛙位分型与术后软骨退变正相关,与术后死骨修复、头臼和谐及关节稳定负相关;(7)术前ARCO分期与术后软骨退变正相关,与术后死骨修复、头臼和谐负相关,与关节稳定无显著相关。
5、Logistic回归显示,与预后相关的危险指标为术前蛙位分型,术前蛙位分型越大则预后越差,术前蛙位分型每加重一个等级,为没有加重时,预后加重这个等级的14.96倍。。
6、逐步cox回归结果显示,在上述与生存时间相关的多因素中,危险指标为术前蛙位分型,术前蛙位分型越大,则股骨头生存时间越小,术前蛙位分型每增大一个等级则生存时间减少的可能性是无增大时的6.937倍。
结论:1、蛙位分型可以客观地反映股骨头前外侧柱坏死分布和塌陷情况,股骨头前外侧柱的完整性和稳定性与股骨头坏死预后和保髋疗效正相关,股骨头前外侧柱越完整越稳定,预后和保髋疗效就越好。正、蛙位分型相结合比单独正位分型能更全面地揭示股骨头前外侧柱的整体状况,减少观察盲区,具有更强的判断预后和评价疗效的能力,有利于中医辩证施治。
2、蛙位分型没有超过C1型,并且坏死区域为前外侧柱残留的正常骨质所包容,形成“包容性修复”,则预后良好;如果蛙位分型达C2型,并且坏死区域是开放的,没有前外侧柱正常骨质的保护,形成“开放性坏死,尤其是横贯股骨头的坏死区”,则预后不良。
3、围塌陷期的保髋手术要围绕着修复股骨头前外侧柱的完整性并尽可能维持其稳定性、防止发生严重的再塌陷这个核心进行。
4、改良减压植骨内稳定术只适用于蛙位分型C1型及以下者,不适用于蛙位分型达C2者。
5、髓芯减压的方向在尽可能保存残留的前外侧柱正常骨质的基础上,以股骨头前外侧的坏死中心区为宜;髓芯减压的深度要达软骨下骨板但不能穿出软骨面;松质骨打压的程度以股骨头基本恢复球形和头内新月征、台阶征和裂隙征基本消失为度,打压的质骨的厚度以5mm为宜;植入腓骨的条近端要修平,四周用1.5mm的克氏针钻孔;内稳定的空心加压螺钉要放在腓骨的正后方或者后内方。
Background.Steroid-induced Osteonecrosis of the Femoral Head(SONFH)is still one of unfathomed issues of Orthopaedics.Currently it has occupied assumably 50%of all Osteonecrosis of the Femoral Head(ONFH)cases,and has became a common disease with high incidence and risk of disabled.Collapse of femoral head is ubiquitous during the course of ONFH.It is the key of the conversion of the diseases.Once ONFH occurs,the clinical linchpin is how to predict and prevent collapse.Numerous factors are relative with the collapse of necrotic femoral head,presently cognition of collapse is still lack of entirety and accuracy.On the one hand,the clinical doctors are devoid of simple,convenient, feasible means to estimate prognosis and evaluate the Joint-Preserving Procedures curative effect.On the other hand,they are also short of effective measures to correct collapse and maintain the biomechanics stabilization of femoral head.According to acetabulum anatomic regions,acetabulum stress force distribution,femoral head stress force distribution,the characteristic of femoral head necrotic zone distribution and necrotic femoral head collapse,and the insufficiency of the anteroposterior x-ray view classification of osteonecrosis,illuming by Ohzono and Sugano,the author develops the frog leg view classification of osteonecrosis which was firstly established by LIU Shao Jun MD,and make a hypothesis that the anterolateral column of femoral head has a consanguineous relativity with prognosis and the Joint-Preserving Procedures curative effect of the SONFH.The author also assumes that the anteroposterior x-ray view classification combines with the frog leg view classification of osteonecrosis can reflect the conditions of the the anterolateral column of femoral head precisely,so that it can be used to estimate prognosis and evaluate the Joint-Preserving Procedures curative effect accurately.In order to testify the hypothesis above,the author carry out an clinic investigation.
Method.All patients who were hospitalized in Department of Arthrosis Surgery of the 1~(st) affiliated hospital of GuangZhou University of Traditional Chinese Medicine were recruited strictly in the light of diagnosis criteria,bringing into criteria and excluding criteria devised in the project between January 2004 and December 2006.Then finally we get 35 SONFH cases(61 hips)which fulfilled the criteria above.All patients' general information,basic disease,usage of Steroid,single or bilateral involved,ARCO Stage, Anteroposterior x-ray view and Flog Leg x-ray view Classification,Modified Index of necrotic extent before collapse,Collapse Degree after collapse,grade of Bone Marrow Edema and Hip Joint Fluid,grade of hip pain,the occure time and degree of post-operation collapse were all registered detailedly.After that evaluate curative effect and put data into the statistical software SPSS13.0 to analyse the results.The termination of Kaplan-Meier survivorship analysis is defined as collapse more than 4 millimeter after operation.
Findings.
1.Total effective rate of this head-preserving procedures was 77.05%,among these excellent rate was 40.98%,good rate was 14.75%,fair rate was 21.31%.General poor rate was 22.95%.There was a high negative correlation between Type C2 and failure,the poor rate of all the cases with Type C2 was near 40%.Excluding Type C2 the other cases' effective rate was 86.84%,excellent rate was 52.63%,good rate was 15.79%,fair rate was 18.42%,poor rate was 13.16%.
2.Traditional Chinese Medicine Syndrome-types Classification.Tagnancy of Qi and Blood Stasis type(TQBS)occupys 50%in all the studied cases.Wind Cold Damp impediment type,Phlegm-dampness type,Qi - deficiency and Phlegm - dampness type, Liver-Kiney deficiency type cannot be found alone.Type TQBS combined with the other four types frequently.Type TQBS mostly combined with Phlegm-dampness type,the combinative rate was 22.22%.
3.Kaplan-Meier survivorship curves demonstrated that the rate of survival of the necrotic femoral head was about 80%for a mean of 24.64 months(range,13-38 months)follow-up at the end of the study.
4.Spearman Rank Correlation Coefficient Assay:
(1)Positive correlation was found between the preoperative anteroposterior x-ray view classification,frog leg view classification and postoperative collapse degree of the anterolateral column of femoral head.
(2)Positive correlation was found between preoperative ARCO stages and postoperative collapse degree of anteroposterior x-ray view of femoral head.The correlation was not statistically significant between preoperative ARCO stages and postoperative collapse degree of frog leg view of femoral head.
(3)Positive correlation was found between preoperative anteroposterior x-ray view collapse degree and postoperative cartilage degeneration.Negative correlation between preoperative anteroposterior x-ray view collapse degree and postoperative necrotic zone restoration,harmony of femeral head and acetabulum,stabilization of hip joint were observed.(4)Positive correlation was found between preoperative frog leg x-ray view collapse degree and postoperative cartilage degeneration.Negative correlation between preoperative frog leg view x-ray collapse degree and postoperative necrotic zone restoration, harmony of femeral head and acetabulum,stabilization of hip joint were observed.
(5)Positive correlation was found between preoperative anteroposterior x-ray view Classification and postoperative cartilage degeneration.Negative correlation between preoperative anteroposterior x-ray view Classification and postoperative necrotic zone restoration,harmony of femeral head and acetabulum,stabilization of hip joint were observed.
(6)Positive correlation was found between preoperative frog leg x-ray view Classification and postoperative cartilage degeneration.Negative correlation between preoperative frog leg x-ray view Classification and postoperative necrotic zone restoration,harmony of femeral head and acetabulum,stabilization of hip joint were observed.
(7)Positive correlation was found between preoperative ARCO stages and postoperative cartilage degeneration.Negative correlation between preoperative ARCO stages and postoperative necrotic zone restoration,harmony of femeral head and acetabulum were observed.The correlation was not statistically significant between preoperative ARCO stages and postoperative stabilization of hip joint
5.Multiple logistic regression analysis showed that the dangerous prognostic index was preoperative frog leg x-ray view Classification.The higer the preoperative frog leg x-ray view Classification,the worse the prognosis was.The preoperative frog leg x-ray view Classification increased per grade leaded to the prognosis increased 14.96 folds compared with the prognosis which the frog leg x-ray view Classification did not increase.
6.COX regression analysis showed that the dangerous index was preoperative frog leg x-ray view Classification among those factors associated with the femoral head survivorship time.The higer the preoperative frog leg x-ray view Classification,the less the femoral head survivorship time was.The preoperative frog leg x-ray view Classification increased per grade leaded to the femoral head survivorship time decreased 6.937 folds compared with the time which the frog leg x-ray view Classification did not increase.
Interpretation.
1.Frog leg view x-ray classification can reflect the distribution of necrotic zone and collapse condition of anterolateral column of femoral head precisely.Positive correlation was found between integrality,stability of anterolateral column of femoral head and prognosis,Joint-Preserving Procedures curative effect of SONFH,the more integrated and stabile,the better the prognosis and curative effect were.The anteroposterior x-ray view classification combined with the frog leg x-ray view classification could reveal the total conditions of the the anterolateral column of femoral head more accurately compared with using the anteroposterior x-ray view classification alone.It also decreased the blind area of observation,was more effective to estimate prognosis and evaluate curative effect,it was propitious to treated SONFH with traditional medicine as well.
2.If the grade of frog leg x-ray view classification did not exceed Type C1,and necrotic zone was contained medially by remained normal bone of anterolateral column of femoral head,forming contained restoration,thus prognosis would be good.If the grade of frog leg x-ray view classification achieved Type C2 and necrotic region was open without protection of normal bone of anterolateral column,forming open restoration,especially generating traversing femoral head necrotic portion,thus the prognosis would be poor.
3.Joint-Preserving Procedures during peri-collapse period should aim at restoring the integrality and maintaining the stability of anterolateral column of femoral head,avoiding severe recollapse.
4.Modified core decompression combined with non-vascularized fibula graft,impaction bone grafting and stabilization inner femoral head with titanium hollow compression screw procedure was only applicable to frog leg x-ray view classification equal and less than type C1,it was inapplicable to type C2.
5.Orientation of core decompression shoud aim at the center of necrotic zone in femoral head anterolateral column preserving as much as possible normal bone of anterolateral femoral head portion.Depth of core decompression shoud achieve subchondral bone plate but never traverse through chondral.The degree of impaction bone grafting should be limited in recovering the shape of femoral head,eliminating the crescent sign,sidestep sign and crack sign in femoral head.Depth of impaction bone grafting should be limited in 5 millimeter.The peak of implanted fibula shuld be cut flat and drilled around its body with Kirschner wire(1.5 mm diameter).The titanium hollow compression screw stabilized femoral head inner should be located just behind or posterior and medial behind the fibula.
引文
1 Pietrogande V,Mastromarino R.Osteopat da prolungata trattamento cortisonico[J].Orthop Traum Appar Mat,1957,25:791-810.
2 Jones JP jr.Etiology and pathogenesis of 0steonecrtosis[J].Clin Orthop,1994,14:153.
3 Koshihara Y,Hoshi K,Okawara R,at al.Vitamin K stimulates osteoblastogenesis and inhibits osteoclastogenesis in human bone marrow cell culture[J].J Endocrinol,2003,176(3):339-348.
4 Felson DT,Anderson JJ.Across-study evaluation of association between steroid dose and bolus steroids and avaseular necrosis of bone[J].Lancet,1987,85(38):902-906.
5 Lausten GS,Lemser T,Jensen PK,et al.Necrosis of the fernoral head after kidney transplantation[J].Clin Transplant,1998,12(6):572-574.
6 Omuma K,Harada Y.Nawata Y.et al.Osteonecrosis in patients with systemic lupus erythematosus develops very early after starting high dose cortieosteroid treatment[J].Ann Rheum Dis,2001,60:1145-1148.
7 Miller K D,M asur H,Jones E C,et al.High prevalence of osteonecrosis of the femoral head in HIV-infected adults[J].AnnIntem Med,2002,137(5):17-22.
8 程晓光,屈辉,刘薇,等.SARS康复患者骨坏死改变的MRI筛查[J].中华放射学杂志,2004,38(3):230.
9 李子荣,孙伟,屈辉,等.皮质类固醇与骨坏死关系的临床研究[J].外科杂志,2005,43(16):1048-1053.
10 Jones JP.Epidemiologlcal risk factors for non-traumatic osteonecrosis[J].Orthopade,2000,29(5):370-379.
11 Saito S.Ohzono K,Ono K.Early artempathy and postulated pathogenesis of the femoral head[J].Clin Orthop,1992,277:98.
12 Atsumi T,Yoshikatsr K.Role of blood supply of the femoral head in the pathogenesis of idiopathic osteonecrosis[J].Clin Orthop,1992,277:22.
13 Wang GJ,Cui Q.The Pathogenesis Of Steroid-Induced Osteonecrosis and the Effect of Lipid Clearing Agents on this Mechanism[J].Osteonecrosis,1997,22:159-166.
14 Ficat P,Axlet J,Hugerford DS.Ischemia and necrosis of bone[J].Baltimore:Williams and Wilkins,1981:1-5.
15 Hirano K,Tsutsui H,Sugioka Y,et al.Histopathologic alterations of retinacular vessels and osteonecrosis[J].Clin Orthop,1997,342:192.
16 Nishimura T,Matsumoto T,Nishino M,et al.Histopatbologic study of veins in steroid treated rabbits[J].Clin Orthop,1997,334:37.
17 Jones JP.Intravascular coagulation and osteonecrosis[J].Clin Orthop,1992,277:41.
18 Jones LC,Mont MA,Le TB,et al.Proeoagulants and osteonecrosis[J].J Rheumatol,2003,30(4):783.
19 Korompilias AV,Ortel TL,Urbaniak JR.Coagulation abnormalities in patients with hip osteonecrosis[J].Orthop Clin North Am,2004,35(3):265-271.
20 李峻辉,宁亚功,叶建红,等.激素性股骨头坏死家兔血液流变学及血脂观察[J].云南医药,2003,24(2):82-84.
21 姚永东,王国毓,杨毓华,等.激素性股骨头坏死动物血液流变学的观察[J].中医正骨,2000,12(4):6-7.
22 胡长根,陈君长,刘强,等.激素对股骨头微血管及组织细胞的影响[J].中华骨科杂志,2004,24(6):359.
23 李月白.激素诱导骨髓基质细胞成脂分化的实验研究[J].中华骨科杂志,1999,19(11):687-689.
24 王昊,周金水.激素性股骨头缺血性坏死的病理研究进展[J].现代中西医结合杂志,2005,14(23):3184-86
25 Cui Q,Wang CJ,Balian C.Steroid-induced adipogenesis pluripotential cell line fi-om bone marrow[J].J Bone Joint Surg(Am),1997,79:1054-63.
26 Oreffo RO,Virdi AS,Triffiu JT.Modulation of osteogenesis and adipogenesis by human serum m human bone Marrow cultrues[J].Eur J Cell Biol,1997,74:251-261.
27 薛元锁,时述山,李亚非,等.激素性股骨头坏死病程中骨形态发生蛋白-2的改变及其意义[J].中华实验外科杂志,2000,17(5):455.
28 Weinstein RS,Jilka R.L,Parfitt AM,et al.Inhibition of osteoblastogenesis and promotion of apoptosis of osteoblasts and osteoeytes by glucecortieoids.Potential mechanisms of their deleterious elects on bone[J].J Clin Invest,1998,102(2):274-282.
29 Hofbauer LC,Gorl F,Riggs BL,et al.Stimulation of osteoprotegerin ligand and inhibition of osteoprotegerin production by glucoeortieoids in human osteoblastic lineage cells:potential paracrine mechanisms of glucocorticoid-induced osteopomsis[J].Endocrinologi,1999,140:4382-4389.
30 Wang G J,Cui Q,Balian G.The pathogenesis and prevention of steroid-reduced osteonecrosis[J].Clin Orthop,2000,370:295-310.
31 Hemigou P,Beaujean F,Lambotte JC.Decrease in the mesenehymal stem cell pool in the proximal femur in corticosteroid-induced osteoneerosis[J].J Bone Joint Surg Bt,1999,81(2):349-355.
32 Li X,Jin L,Cui Q,et al.Steroid effects on osteogenesis through mesenchymal cel gene expression[J].Osteoporos Int,2004,15:1.
33 Asano T,Takahashi KA,Fujioka M,et al.ABCB1 C3435T and G2677T / A polymorphism decreased the risk for steroid-induced osteonecrosis of the femoral head after kidney transplantation[J].Pharmaeogenetics,2003,13(11):675-682.
34 Lieberma JR,Berry DJ,Mont MA,et al.Osteonecrosis of the hip:managemem in the 21st century[J].Instr Course Leer,2003,52:337-355.
35 Celik A,Tekis D,Saglam F,et al.Association of corticosteroids and factor V,prothrombin,and MTHFR gene mutations with avascular osteonecrosis in renal allagraft recipients[J].Transplant Proc,2006,38:512-516.
36 Zalavras CG,Vartholomatos G,Dokou E,et al.Factor V Leiden and prothrombin gene mutations in femoral head osteonecrosis[J].Thromb Haemost,2002,87:1079-1080.
37 Liu YF,Chen WM,Lin YF,et al.Type Ⅱ collagen gene variants and inherited osteoneerosis of the femoral head[J].N Engl J Med,2005,352:2294-2301.
38 Proekop DJ.Type Ⅱ collagen and avascular necrosis of the femoral head[J].N Ensl J Med,2005,352:2268-2270.
39 Chen WP,Tai CL,Tan CF,et al.The degrees to which transtrochanteric rotational osteotomy moves the region of osteonecrotic femoral head out of the weight-bearing area as evaluated by computer simulation[J].Clin Biomech(Bristol,Avon),2005,20(1):63-9.
40 M.Kumagai,Y.H.Kim,N.Inoue,et al.3-D Dynamic Hip Contact Pressure Distribution In Daily Activities[J].2003 Summer Bioengineering Conference,June 25-29,Sonesta Beach Resort in Key Biscayne,Florida,2003.
41 Yoshida H,Faust A,Wilckens J,et al.Three-dimensional dynamic hip contact area and pressure distribution during activities of daily living[J].J Biomech,2006,39(11):1996-2004.
42 Harnroongroj T.The role of the anterior column of the acetabulum on pelvic stability:a biomechanical study[J].Injury,1998,29:293-6.
43 裘世静.正常股骨头骨小梁的拱结构特征及其生物力学意义[J].中华外科杂志,1991,29(8):487.
44 俞超,薛文东,张双燕,等.股骨头负重区松质骨的压缩力学特性[J].上海生物医学工程杂志,2004.25(1):22.
45 赵宝林,程杰平,马洪顺,等.股骨头松质骨力学性质实验研究[J].医用生物力学,2003,18(4):234.
46 杨善卿.单髓负重的生物力学探讨[J].生物力学,1990,5(7):92.
47 Genda E,Iwasaki N,Li G,et al.Normal hip joint contact pressure distribution in single-leg standing-effect of gender and anatomic parameters[J].J Biomeeh,2001,34(7):895-905.
48 高士濂.实用解剖图谱[M].上海科学技术出版社,2004:358-363.
49 Letoumel E.Acetabulum fractures:classification and management[J].Clin Orthop Relat Res,1980:81-106.
50 Matta JM,Anderson LM,Epstein HC,et al.Fractures of the acetabulum.A retrospective analysis[J].Clin Orthop Relat Res,1986,205(6):230-40.
51 KNIGHT RA,SMITH H.Central fractures of the acetabuhim[J].J Bone Joint Surg Am,1958,40-A(1):1-16 passim.
52 von Eisenhart R,Adam C,Steinlechner M,et al.Quantitative determination of joint incongruity and pressure distribution during simulated gait and cartilage thickness in the human hip joint[J].J Orthop Res,1999,17(4):532-9.
53 Brown TD,Way ME,Ferguson AB Jr.Mechanical characteristics of bone in femoral capital aseptic necrosis[J].Clin Orthop Relat Res,1981:240-7.
54 Kim YM,Lee SH,Lee FY,et al.Morphologic and biomechanical study of avascular necrosis of the femoral head[J].Orthopedics,1991,14:1111-6.
55 王金熙,董天华,陈贤志,等.实验性股骨头缺血性坏死修复过程的生物力学研究[J].中华外科杂志,1993,31(6):374.
56 Magnussen RA,Guilak F,Vail TP.Cartilage degeneration in post-collapse cases of osteonecrosis of the human femoral head:altered mechanical properties in tension,compression,and shear[J].J Orthop Res,2005,23:576-83.
57 Brown TD,Mutschler TA,Ferguson AB Jr.A non-linear finite element analysis of some early collapse processes in femoral head osteonecrosis[J].J Biomech,1982,15:705-15.
58 Ueo T,Tsutsumi S,Yamamuro T,et al.Biomechanical aspects of the development of aseptic necrosis of the femoral head[J].Arch Orthop Trauma Surg,1985,104:145-9.
59 Brown TD,Baker KJ,Brand RA.Structural consequences of subchondral bone involvement in segmental osteonecrosis of the femoral head[J].J Orthop R.es,1992,10:79-87.
60 Van Rietbergen B,Muller R,Ulrich D,et al.Tissue stresses and strain in trabeculae of a canine proximal femur can be quantified from computer reconstructions[J].J Biomech,1999,32:443-51.
61 Yang JW,Koo KH,Lee MC,et al.Mechanics of femoral head osteonecrosis using three-dimensional finite element method[J].Arch Orthop Trauma Surg,2002,122(2):88-92.
62 Daniel M,Herman S,Dolinar D,et al.Contact stress in hips with osteonecrosis of the femoral head[J].Clin Orthop Relat Res,2006,447:92-9.
63 王伟,刘朋,等.成人股骨头坏死塌陷的发病机理及诊治进展[J].医学信息:医学与计算机应用,2000,13(12):696-8.
64 Brown TD,Mutsehler TA,Ferguson AB Jr.A non-linear finite element analysis of some early collapse processes in femoral head osteoneerosis[J].J Biomech,1982,15:705-15.
65 Mont MA,Jones LC,Einhorn TA,et al.Osteonecrosis of the femoral head.Potential treatment with growth and differentiation factors[J].Clin Orthop Relat Res,1998:S314-35.
66 张永飞,张义修.股骨颈骨折术后股骨头坏死的力学因素[J].骨与关节损伤杂志,2001,16(4):270.
67 Kerboul M,Thomine J,Postel M,et al.The conservative surgical treatment of idiopathic aseptic necrosis of the femoral head[J].J Bone Joint Surg Br,1974,56:291-6.
68 Steinberg ME,Bands RE,Parry S,et al.Does lesion size affect the outcome in avascular necrosis?[J].Clin Orthop Relat Res,1999:262-71.
69 Ohzono K,Saito M,Takaoka K,et al.Natural history of nontraumatic avascular necrosis of the femoral head[J].J Bone Joint Surg Br,1991,73:68-72.
70 Sugano N,Takaoka K,Ohzono K,et al.Prognostication of nontraumatic avascular necrosis of the femoral head.Significance of location and size of the necrotic lesion[J].Clin Orthop Relat Res,1994:155-64.
71 Kokubo T,Takatori Y,Ninomiya S,et al.Magnetic resonance imaging and scintigraphy of avascular necrosis of the femoral head.Prediction of subsequent segmental collapse[J].Clin Orthop Relat Res,1992:54-60.
72 Takatori Y,Kokubo T,Ninomiya S,et al.Avascular necrosis of the femoral head.Natural history and magnetic resonance imaging[J].J Bone Joint Surg Br,1993,75:217-21.
73 Iwasada S,Hasegawa Y,Iwase T,et al.Bone scintigraphy and magnetic resonance imaging after transtroehanteric rotational osteotomy[J].Skeletal Radiol,1999,28:251-9.
74 Bassett LW,Mirra JM,Cracehiolo A 3rd,et al.Isehemic necrosis of the femoral head.Correlation of magnetic resonance imaging and histologic sections[J].Clin Orthop Relat Res,1987:181-7.
75 王刚,赵国库,张新,等.股骨头缺血性坏死的磁共振影像与骨小梁强度分析[J].中华医学杂志,1998,78(6):467-9.
76 张新,王刚,孙磊,等.非创伤性股骨头缺血性坏死的磁共振影像与多平面骨组织计量学的对照研究[J].白求恩医科大学学报,1998,24(4):423-4.
77 Beltran J,Knight CT,Zuelzer WA,et al.Core decompression for avascular necrosis of the femoral head:correlation between long-term results and preoperative MR staging[J].Radiology,1990,175:533-6.
78 Sugano N,Ohzono K,Masuhara K,et al.Prognostication of osteonecrosis of the femoral head in patients with systemic lupus erythematosus by magnetic resonance imaging[J].Clin Orthop Relat Res,1994:190-9.
79 Kubo T,Yamazoe S,Sugano N,et al.Initial MRI fmdings of non-traumatic osteonecrosis of the femoral head in renal allograft recipients[J].Magn Reson Imaging,1997,15:1017-23.
80 Shimizu K,Moriya H,Akita T,et al.Prediction of collapse with magnetic resonance imaging of avaseular necrosis of the femoral head[J].J Bone Joint Surg Am,1994,76:215-23.
81 Sakamoto M,Shimizu K,Iida S,et al.Osteonecrosis of the femoral head:a prospective study with MRI[J].J Bone Joint Surg Br,1997,79:213-9.
82 Ito H,Matsuno T,Kaneda K.Prognosis of early stage avascular necrosis of the femoral head[J].Clin Orthop Relat Res,1999:149-57.
83 Lafforgne P,Dahan E,Chagnaud C,et al.Early-stage avascular necrosis of the femoral head:MR imaging for prognosis m 31 cases with at least 2 years of follow-up[J].Radiology,1993,187:199-204.
84 Koo KH,Kim R.Quantifying the extent of osteonecrosis of the femoral head.A new method using MRI[J].J Bone Joint Surg Br,1995,77:875-80.
85 赵凤朝,李子荣,张念非,等.坏死面积比例在预测股骨头塌陷中的价值[J].中华骨科杂志,2005.25(9):520-3.
86 Cherian SF,Laorr A,Saleh KJ,et al.Quantifying the extent of femoral head involvement in osteonecrosis[J].J Bone Joint Surg Am,2003,85-A:309-15.
87 Nishii T,Sugano N,Ohzono K,et al.Significance of lesion size and location m the prediction of collapse of osteonecrosis of the femoral head:a new three-dimensional quantification using magnetic resonance imaging[J].J Orthop Res,2002,20:130-6.
88 Hemigou P,Lambotte JC.Volumetric analysis of osteonecrosis of the femur.Anatomical correlation using MRI[J].J Bone Joint Surg Br,2001,83:672-5.
89 Penix AR,Cook SD,Skinner HB,et al.Femoral head stresses following cortical hone grafting for aseptic necrosis.A finite element study[J].Clin Orthop Relat Res,1983,(173):159-65.
90 Brown TD,Pedersen DR,Baker KJ,et al.Mechanical consequences of core drilling and bone-grafting on osteonecrosis of the femoral head[J].J Bone Joint Surg Am,1993,75(9):1358-67.
91 Sakamoto J,Brown TD.Toward determining construct mechanical optimality for fibular bone grafting in femoral head osteonecrosis[J].Iowa Orthop J,1996,16:79-87.
92 Nagoya S,Nagao M,Takada J,et al.Predictive factors for vascularized iliac bone graft for nontraumatic osteonecrosis of the femoral head[J].J Orthop Sci,2004,9(6):566-70.
93 Hofmann S,Mazieres B.Osteonecrosis:natural course and conservative therapy[J].Orthopade,2000,29:403-10.
94 Garino JP,Steinberg ME.Total hip arthroplasty in patients with avascular necrosis of the femoral head:a 2- to 10-year follow=up[J].Clin Orthop Relat Res,1997:108-15.
95 刘少军.王海彬,袁浩.生脉成骨片对早期股骨头坏死塌陷的影响[J].新中医,2007,33(9):49-52.
96 Cui Q,Wang G J,Su CC,et al.The Otto Aufranc Award.Lovastatin prevents steroid induced adipogenesis and osteonecrosis[J].Clin Orthop Relat Res,1997:8-19.
97 Pritchett JW.Statin therapy decreases the risk of osteonecrosis in patients receiving steroids[J].Clin Orthop Relat Res,2001:173-8.
98 Wang G J,Cui Q,Balian G.The Nicolas Andry award.The pathogenesis and prevention of steroid-induced osteonecrosis[J].Clin Orthop Relat Res,2000:295-310.
99 Li X,Jin L,Cui Q,et al.Steroid effects on osteogenesis through mesenchymal cell gene expression[J].Osteoporos Int,2005,16:101-8.
100 王卫东,廖文胜,王义生.辛伐他汀预防激素性股骨头坏死的实验研究[J].郑州大学学报(医学版),2004,39(3):473-5.
101 Maruno H,Shimizu T,Kawai K,et al.The response of osteocytes to a lipid clearing agent in steroid-treated rabbits[J].J Bone Joint Surg Br,1991,73:911-5.
102 周谋望,秦建中,刘志雄,等.降脂药物防治激素所致股骨头骨细胞损害的实验研究[J].中华医学杂志,1996,76(1):13-6.
103 Masuhara K,Nakata K,Yamasaki S,et al.Involvement of platelet activation in experimental osteonecrosis in rabbits[J].Int J Exp Fathol,2001,82:303-8.
104 刘万林,郭文通,李文琪,等.抗凝改善骨内微循环治疗激素性股骨头缺血性坏死的初步观察[J].内蒙古医学院学报,1999,21(4):235-6.
105 廖文胜,王义生,高远,等.激素性股骨头坏死发病机制及藻酸双酯钠的干预作用[J].河南医药信息,2001,9(10):1-3.
106 李卫哲,李景南,张新.抗凝药物预防激素所致股骨头坏死[J].吉林大学学报(医学版),2003,29(4):475-476.
107 Glueck CJ,Freiberg RA,Wang P.Role of thrombosis in osteonecrosis[J].Curr Hematol Rep,2003,2:417-22.
108 Norman D,Miller Y,Sabo E,et al.The effects of enoxaparin on the reparative processes in experimental osteoneerosis of the femoral head of the rat[J].APMIS,2002,110:221-8.
109 Reis ND,Schwartz O,Militianu D,et al.Hyperbaric oxygen therapy as a treatment for stage-I avascular necrosis of the femoral head[J].J Bone Joint Surg Br,2003,85:371-5.
110 陈卓明,程秀萍,张岷波,等.高压低频脉冲直流电治疗股骨头缺血性坏死临床观察[J].中国疗养医学,2002,11(2):10-1.
111 韩永台,米立新,李欣,等.分米波治疗股骨头缺血性坏死[J].中华理疗杂志,1999,22(2):72-4.
112 Russo S,Galasso O,Gigliotti S,et al.Shockwave treatment for osteonecrosis of the hip.Musculoskeletal shockwave therapy[J].1 st ed ed.London:Greenwich Medical Ltd,2000.231-40.
113 曹殿波,杨海山,赵永生,等.成人股骨头缺血坏死介入治疗的临床疗效分析[J].白求恩医科大学学报,2001,27(5):529-31.
114 李喜东.介入治疗激素性股骨头坏死的实验研究[J].中华放射学杂志,1998,32(1):32-5.
115 权毅.股骨头缺血坏死介入治疗的临床观察[J].骨与关节损伤杂志,2001,16(5):336-8.
116 Hungerford DS.Early diagnosis of ischemic necrosis of the femoral head[J].Johns Hopkins Med J,1975,137:270-5.
117 Ficat RP.Idiopathic bone necrosis of the femoral head.Early diagnosis and treatment[J].J Bone Joint Surg Br,1985,67:3-9.
118 李毅中,乐铜.特发性股骨头坏死的诊断与治疗[J].中华外科杂志,1989,6:337-341.
119 郑召民,许振华.骨内压研究的进展[J].河南医学研究,1995,4:190-192.
120 Wilkes CH,Visscher MB.Some physiological aspects of bone marrow pressure[J].J Bone Joint Surg Am,1975,57:49-57.
121 张毓洲,许露玫,许振华,等.正常与骨内高压下骨髓微循环冷冻割断扫描电镜观察[J].中华骨科杂志,1999,19:303-5.
122 和树政,许振华,刘保民.骨内高压下骨微循环形态扫描电镜观察[J].中华骨科杂志,1990,11:215-218.
123 Chan TW,Dalinka MK,Steinberg ME,et al.MRI appearance of femoral head osteonecrosis following core decompression and bone grafting[J].Skeletal Radiol,1991,20:103-7.
124 Plenk H Jr,Gstettner M,Grossschrnidt K,et al.Magnetic resonance imaging and histology of repair in femoral head osteonecrosis[J].Clin Orthop Relat Res,2001:42-53.
125 Aigner N,Schneider W,Ebed V,et al.Core decompression in early stages of femoral head osteonecrosis-an MRI-controlled study[J],hat Orthop,2002,26:31-5.
126 Specchiulli F.Core decompression in the treatment of necrosis of the femoral head.Long-term results[J].Chit Organi Mov,2000,85:395-402.
127 Mont MA,Carbone JJ,Fairbank AC.Core decompression versus nonoperative management for osteonecrosis of the hip[J].Clin Orthop Relat Res,1996:169-78.
128 Steinberg ME,Larcom PG,Stratford B,et al.Core decompression with bone grafting for osteonecrosis of the femoral head[J].Clin Orthop Relat Res,2001:71-8.
129 Yoon TR,Song EK,Rowe SM,et al.Failure after core decompression in osteonecrosis of the femoral head[J],hat Orthop,2001,24:316-8.
130 Camp JF,Colwell CW Jr.Core decompression of the femoral head for osteonecrosis[J].J Bone Joint Surg Am,1986,68:1313-9.
131 Simank HG,G-raf J,Kerber A,et al.Long-term effects of core decompression by drilling.Demonstration of bone healing and vessel ingrowth in an animal study.[J]Acta Anat(Basel),1997,158:185-91.
132 Chang MC,Chen TH,Lo WH.Core decompression in treating ischemic necrosis of the femoral head[J].Zhonghua Yi Xue Za Zhi(Taipei),1997,60:130-6.
133 Castro FP Jr,Barrack RL.Core decompression and conservative treatment for avascular necrosis of the femoral head:a meta-analysis[J].Am J Orthop,2000,29:187-94.
134 Soucacos PN,Beris AE,Malizos K,et al.Treatment of avascular necrosis of the femoral head with vascularized fibular transplant[J].Clin Orthop Relat Res,2001:120-30.
135 Leali A,Fetto J,Hale JJ.Biostructural augmentation for the treatment of osteonecrosis:rationale,technique,and case example[J].J South Orthop Assoc,2002,11:167-71.
136 Berend KR,Gunneson EE,Urbaniak JP,..Free vascularized fibular grafting for the treatment of postcollapse osteonecrosis of the femoral head[J].J Bone Joint Surg Am,2003,85-A:987-93.
137 Lieberman JR.Core decompression for osteonecrosis of the hip[J].Clin Orthop Relat Res,2004:29-33.
138 Gonzalez Della Valle A,Bates J,Di Carlo E,et al.Failure of free vascularized fibular graft for osteonecrosis of the femoral head:a histopathologic study of 6 cases[J].J Arthroplasty,2005,20:331-6.
139 梅荣成,杨述华,杨操,等.钛合金支撑架结合自体骨和DBM治疗股骨头坏死[J].中国矫形外科杂志,2006,14(7):509-11.
140 何伟,袁浩,李雄,等.多条血管束植入治疗成人股骨头坏死的远期疗效观察[J].骨与关节损伤杂志,2000,15(4):261-2.
141 范丽娟,苏奇,余焕群.多组血管束植入股骨头修整与再造治疗中晚期股骨头缺血性坏死[J].骨与关节损伤杂志,2003,18(9):596-7.
142 Mont MA,Einhom TA,Sponseller PD,et al.The trapdoor procedure using autogcnous cortical and cancellous bone grafts for osteonecrosis of the femoral hcad[J].J Bone Joint Surg Br,1998,80:56-62.
143 曾述强,张功林,葛宝丰,等.经股骨头开瓣植骨术治疗股骨头缺血性坏死[J].中国骨伤,2002,15(12):710-11.
144 杨旭东.介入+异体腓骨移植治疗成人股骨头缺血性坏死[J].临床骨科杂志,2003,6(4):327-9.
145 Hemigou P,Bachir D,Galacteros F.Avascular necrosis of the femoral head in sickle-cell disease.Treatment of collapse by the injection of acrylic cement[J].J Bone Joint Surg Br,1993,75:875-80.
146 Wood ML,McDowell CM,Kerstcttcr TL,et al.Open reduction and cementation for femoral head fracture secondary to avascular necrosis:preliminary report[J].Iowa Orthop J,2000,20:17-23.
147 董天华,刘松,朱国梁,等.羟基磷灰石骨水泥植入治疗成人股骨头缺血性坏死的中期疗效观察[J].中华骨科杂志,2002,22(2):84-87.
148 Jones JP Jr.Alcoholism,hypercortisonism,fat embolism and osseous avascular necrosis[J].Clin Orthop Relat Rcs,2001:4-12.
149 周华江,聂林,张琦,等.碱性成纤维细胞因子对兔股骨头坏死模型实验修复过程的影响[J].中国矫形外科杂志,2002,10(9):895-7.
150 杨操,杨述华,杜靖远,等.bFCF基因转染促进股骨头坏死修复的实验研究[J].中国矫形外科杂志,2004,12(16):1236-1239.
151 Yang C,Yang S,Du J,et al.Vascular endothelial growth factor gene transfection to enhance the repair of avaseular necrosis of the femoral head of rabbit[J].Chin Med J(Engl),2003,116:1544-8.
152 周强,石国华,杨柳,等.复合多孔生物材料在股骨头坏死模型中诱导成骨的观察[J].中华外科杂志,2002,40(6):458-61.
153 周华江,薛强,张琦,等.重组合异种骨治疗股骨头缺血坏死的实验研究[J].中华实验外科杂志, 2004,21(9):1148.
154 Mont MA,Jones LC,Elias JJ,et al.Strut-autografting with and without osteogenic protein-1:a preliminary study of a canine femoral head defect model[J].J Bone Joint Surg Am,2001,83-A:1013-22.
155 Lieberman JR.,Conduah A,Urist MR.Treatment of osteonecrosis of the femoral head with core decompression and human bone morphogenetic protein[J].Clin Orthop Relat Res,2004:139-45.
156 Simank HG,Manggold J,Sebald W,et al.Bone morphogenetic protein-2 and growth and differentiation factor-5 enhance the healing of necrotic bone in a sheep model[J].Growth Factors,2001,19:247-57.
157 李建军,韩东,刘建国,等.BMP-2重组质粒转染人骨髓基质干细胞及表达蛋白的诱导活性观察[J].中华创伤骨科杂志,2004,6(2):190-193.
158 Mont MA,Etienne G,Ragland PS.Outcome of nonvascularized bone grafting for osteonecrosis of the femoral head[J].Clin Otthop Relat Res,2003:84-92.
159 Breitbart AS,Grande DA,Kessler R,et al.Tissue engineered bone repair of calvarial defects using cultured periosteal cells[J].Hast Reconstr Surg,1998,101:567-74;discussion 575-6.
160 徐小良,王坤正,杨增华,等.bBMP-胶元-珊瑚复合人工骨修复股骨头缺损的生物力学研究[J].中国骨伤,2001,14(1):17-9.
161 孙庆仲,闫红艳,郭文希,等.牛脱蛋白松质骨、胶原、BMP、RBM复合物修复骨缺损的实验研究[J].骨与关节损伤杂志,2002,17(6):433-5.
162 尹庆水,张余,李兆麟,等.复合珊瑚羟基磷灰石人工骨的研制和临床应用[J].骨与关节损伤杂志,2003,18(3):147-9.
163 李亚非,常红星,姚建华,等.组织工程化异体骨复合物BMP和自体骨髓治疗股骨头缺血性坏死[J].中华骨科杂志,2005,25(6):337-41.
164 朱盛修.股骨头缺血坏死的显微外科治疗进展[J].中华显微外科杂志,2000,23(4):245-6.
165 Judet H,Gilbert A.Long-term results of free vaseularized fibular grafting for femoral head necrosis[J].Clin Orthop Relat Res,2001:114-9.
166 Urbaniak JR,Coogan PG,Gunneson EB,et al.Treatment of osteonecrosis of the femoral head with free vaseularized fibular grafting.A long-term follow-up study of one hundred and three hips[J].J Bone Joint Surg Am,1995,77:681-94.
167 Urbaniak JR,Harvey EJ.Revascularization of the femoral head in osteonecrosis[J].J Am Aead Orthop Surg,1998,6:44-54.
168 王坤正,同志勤,王春生,等.吻合血管游离腓骨移植治疗股骨头坏死[J].中华显微外科杂志,2000,23(4):254-256.
169 Vail TP,Urbaniak JR.Donor-site morbidity with use of vascularized autogenous fibular grafts[J].J Bone Joint Surg Am,1996,78:204-11.
170 陈振光.带血管蒂股骨大转子骨瓣移植术[J].中华显微外科杂志,1996,19:232.
171 赵德伟,王卫明,王本杰,等.保留股骨头手术治疗股骨头缺血性坏死1005例临床分析[J].中华外科杂志,2005,43(16):1054-7.
172 范启申,周祥吉,周建国,等.成人重度股骨头缺血性坏死显微手术方法的选择[J].中华显微外科杂志,1998,21(1):6-8.
173 赵林,侍德,张其恭.缺血性骨坏死治疗方法比较的实验研究[J].中华外科杂志,1991,20:72.
174 Sugioka Y,Hotokebuchi T,Tsutsui H.Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head.Indications and long-term results[J].Clin Orthop Relat Res,1992:111-20.
175 Mont MA,Fairbank AC,Krackow KA,et al.Corrective osteotomy for osteonecrosis of the femoral head[J].J Bone Joint Surg Am,1996,78:1032-8.
176 Schneider W,Aigner N,Pinggera O,et al.Intertrochanteric osteotomy for avascular necrosis of the head of the femur.Survival probability of two different methods[J].J Bone Joint Surg Br,2002,84:817-24.
177 Onodera S,Majima T,Abe Y,et al.Transtrochanteric rotational osteotomy for osteonecrosis of the femoral head:relation between radiographic features and secondary collapse[J].J Orthop Sci,2005,10:367-73.
178 Nakamura Y,Kumazawa Y,Mitsui H,et al.Combined rotational osteotomy and vascularized iliac bone graft for advanced osteonecrosis of the femoral head[J].J Reconstr Microsurg,2005,21:101-5.
179 Dean MT,Cabanela ME.Transtrochanteric anterior rotational osteotomy for avascular necrosis of the femoral head.Long-term results[J].J Bone Joint Surg Br,1993,75:597-601.
180 邓沂,张晓刚,任远,等.中医对股骨头坏死的认识[J].甘肃中医学院报,1988,15(4):54-6.
181 郭效东,陈卫衡,赵永刚,等.股骨头无菌性坏死三期辩证论治的临床研究(附50倒报告).北京:全国股骨头无菌性坏死学术研讨会论文汇编,1992:310-313.
182 李宇明.袁浩教授治疗股骨头缺血性坏死的学术思想和经验.全国股骨头无菌性坏死学术研讨会论文汇编(北京),1999:11.
183 威新开,藏红亚.桂枝芍药知母汤加味治疗股骨头坏死[J].现代中西医结合杂志,2002,11(17):1695-6.
184 刘少军,袁浩.股骨头坏死的中医临床思路与方法探讨[J].中国医药学报,2002,17(1):44-7.
185 齐振熙,曹阳.不同治法对激素性股骨头坏死血液流变学及血脂影响的实验研究[J].中国中医骨伤科杂志,2001,9(5):30-1.
186 洪加源,许书亮,阮景绰,等.复元散对激素性股骨头环死脂代谢的影响[J].中医正骨,2001,13(4):6-8.
187 张晓刚,任远,王钢,等.生骨散对激素性股骨头坏死家兔血脂的影响[J].2001,14(3):148-9.
188 徐传毅.袁浩教授以血瘀论治激素性股骨头坏死经验[J].中医药学刊,2003,21(2):194-5.
189 陈卫衡,刘道兵,张洪美等.股骨头坏死的三期四型辨证思路[J].中国中医基础医学杂志,2003,9(12):51-2.
190 王峰,丁锷,李保泉.股骨头缺血性坏死的中医分型和治疗[J].中医正骨,2005,17(7):23-4.
191 王萍,高红艳.辨证分型治疗激素性股骨头坏死117例[J].上海中医药大学学报,2003,17(1):36-7.
192 胡心愿,全健,刘英纯.浅淡股骨头坏死的中医三期论治.陕西中医,2006,27(3):314-315.
1 Ohzono K,Saito M,Takaoka K,et al.Natural history of nontraumatic avascular necrosis of the femoral head[J].J Bone Joint Surg Br,1991,73(1):68-72.
2 Sugano N,Atsumi T,Ohzono K,et al.The 2001 revised criteria for diagnosis,classification,and staging of idiopathic osteonecrosis of the femoral head[J].J Orthop Sci,2002,7(5):601-5.
3 Sugano N,Takaoka K,Ohzono K,et al.Prognostication of nontraumatic avascular necrosis of the femoral head.Significance of location and size of the necrotic lesion[J].Clin Orthop Relat Res,1994,303:155-64.
4 高扬,王俊勤,陈伯华.单侧髋关节蛙式位透视在股骨颈骨折内固定手术中的应用及相关问题探讨[J].生物骨科材料与临床研究,2007,4(5):38-40.
5 M.Kumagai,Y.H.Kim,N.Inoue,et al.3-D Dynamic Hip Contact Pressure Distribution In Daily Activities[J].2003 Summer Bioengineering Conference,June 25-29,Sonesta Beach Resort in Key Biscayne,Florida,2003.
6 Yoshida H,Faust A,Wilckens J,et al.Three-dimensional dynamic hip contact area and pressure distribution during activities of daily living[J].J Biomech,2006,39(11):1996-2004.
7 Chen WP,Tai CL,Tan CF,et al.The degrees to which transtrochanteric rotational osteotomy moves the region of osteonecrotic femoral head out of the weight-bearing area as evaluated by computer simulation[J].Clin Biomech(Bristol,Avon),2005,20(1):63-9.
8 Langlais F,Fourastier J.Rotation osteotomies for osteonecrosis of the femoral head[J].Clin Orthop Relat Res,1997,343(10):110-23.
9 Genda E,Iwasaki N,Li G,et al.Normal hip joint contact pressure distribution in single-leg standing—effect of gender and anatomic parameters[J].J Biomech,2001,34(7):895-905.
10 杨善卿.单髓负重的生物力学探讨[J].生物力学,1990,5(7):92.
11 Matta JM,Anderson LM,Epstein HC,et al.Fractures of the acetabulum.A retrospective analysis[J].Clin Orthop Relat Res,1986,205(6):230-40.
12 Yang JW,Koo KH,Lee MC,et al.Mechanics of femoral head osteoneerosis using three-dimensional finite element method[J].Arch Orthop Trauma Surg,2002,122(2):88-92.
13 Daniel M,Herman S,Dolinar D,et al.Contact stress in hips with osteonecrosis of the femoral head[J].Clin Orthop Relat Res,2006,447:92-9.
14 李子荣.股骨头坏死诊断与治疗的专家建议[J].中华骨科杂志,2007,27(2):146-8.
15 Cherian SF,Laorr A,Saleh KJ,et al.Quantifying the extent of femoral head involvement in osteonecrosis[J].J Bone Joint Surg Am,2003,85-A(2):309-15.
16 Takashi Nishii,MD,Nobuhiko Sugano,MD,Kenji Ohzono,MD,et al.Progression and Cessation of Collapse in Osteonecrosis of the Femoral Head[J].Clin Orthop Relat Res,2002,400:149-157.
17 赵培荣,庄奇新,乔瑞华,等.股骨头缺血坏死骨髓水肿的MRI研究[J].实用放射学杂志,2006,22(7):835-7.
18 Moss SG,Schweitzer ME,Jacobson JA,ctal.Hip joint fluid:detection and distribution at MR imaging and US with cadaveric correlation[J].Radiology,1998,208(1):43-8.
19 南登昆,缪鸿石.康复医学[M].北京:人民卫生出版社,1993,95.
20 郝延科,刘祖振,等.审校:张世华.股骨头坏死的早期影像学诊断[J].中国中西医结合影像学杂志,2004,2(3):232-4.
21 马在松综述,史振满审校.早期股骨头坏死的诊断及鉴别诊断[J].中国矫形外科杂志,2001,8(5):503-5.
22 李常山.股骨头缺血坏死的影像学诊断[J].山东医药,2006,46(34):81-2.
23 王岩,朱盛修.成人股骨头缺血性坏死的治疗与疗效评价法[J].解放军医学杂志,1998,23(1):77-8.
24 Brown TD,Pedersen DR,Baker KJ,et al.Mechanical consequences of core drilling and bone-grafting on osteonecrosis of the femoral head[J].J Bone Joint Surg Am,1993,75(9):1358-67.
25 Penix AR,Cook SD,Skinner HB,et al.Femoral head stresses following cortical bone grafting for aseptic necrosis.A finite element study[J].Clin Orthop Relat Res,1983,(173):159-65.
26 Sakamoto J,Brown TD.Toward determining construct mechanical optimality for fibular bone grafting in femoral head osteonecrosis[J].Iowa Orthop J,1996,16:79-87.
27 Nagoya S,Nagao M,Takada J,et al.Predictive factors for vascularized iliac bone graft for nontraurnatic osteonecrosis of the femoral head[J].J Orthop Sci,2004,9(6):566-70.
28 王伟,刘朋,等.成人股骨头坏死塌陷的发病机理及诊治进展[J].医学信息:医学与计算机应用,2000,13(12):696-8.
29 刘少军,袁浩.股骨头坏死的中医临床思路与方法探讨[J].中国医药学报,2002,17(1):44-7.
30 陈卫衡,刘道兵,张洪美等.股骨头坏死的三期四型辨证思路[J].中国中医基础医学杂志,2003,9(12):51-2.
2 Jones JP jr.Etiology and pathogenesis of 0steonecrtosis[J].Clin Orthop,1994,14:153.
3 Koshihara Y,Hoshi K,Okawara R,at al.Vitamin K stimulates osteoblastogenesis and inhibits osteoclastogenesis in human bone marrow cell culture[J].J Endocrinol,2003,176(3):339-348.
4 Felson DT,Anderson JJ.Across-study evaluation of association between steroid dose and bolus steroids and avaseular necrosis of bone[J].Lancet,1987,85(38):902-906.
5 Lausten GS,Lemser T,Jensen PK,et al.Necrosis of the fernoral head after kidney transplantation[J].Clin Transplant,1998,12(6):572-574.
6 Omuma K,Harada Y.Nawata Y.et al.Osteonecrosis in patients with systemic lupus erythematosus develops very early after starting high dose cortieosteroid treatment[J].Ann Rheum Dis,2001,60:1145-1148.
7 Miller K D,M asur H,Jones E C,et al.High prevalence of osteonecrosis of the femoral head in HIV-infected adults[J].AnnIntem Med,2002,137(5):17-22.
8 程晓光,屈辉,刘薇,等.SARS康复患者骨坏死改变的MRI筛查[J].中华放射学杂志,2004,38(3):230.
9 李子荣,孙伟,屈辉,等.皮质类固醇与骨坏死关系的临床研究[J].外科杂志,2005,43(16):1048-1053.
10 Jones JP.Epidemiologlcal risk factors for non-traumatic osteonecrosis[J].Orthopade,2000,29(5):370-379.
11 Saito S.Ohzono K,Ono K.Early artempathy and postulated pathogenesis of the femoral head[J].Clin Orthop,1992,277:98.
12 Atsumi T,Yoshikatsr K.Role of blood supply of the femoral head in the pathogenesis of idiopathic osteonecrosis[J].Clin Orthop,1992,277:22.
13 Wang GJ,Cui Q.The Pathogenesis Of Steroid-Induced Osteonecrosis and the Effect of Lipid Clearing Agents on this Mechanism[J].Osteonecrosis,1997,22:159-166.
14 Ficat P,Axlet J,Hugerford DS.Ischemia and necrosis of bone[J].Baltimore:Williams and Wilkins,1981:1-5.
15 Hirano K,Tsutsui H,Sugioka Y,et al.Histopathologic alterations of retinacular vessels and osteonecrosis[J].Clin Orthop,1997,342:192.
16 Nishimura T,Matsumoto T,Nishino M,et al.Histopatbologic study of veins in steroid treated rabbits[J].Clin Orthop,1997,334:37.
17 Jones JP.Intravascular coagulation and osteonecrosis[J].Clin Orthop,1992,277:41.
18 Jones LC,Mont MA,Le TB,et al.Proeoagulants and osteonecrosis[J].J Rheumatol,2003,30(4):783.
19 Korompilias AV,Ortel TL,Urbaniak JR.Coagulation abnormalities in patients with hip osteonecrosis[J].Orthop Clin North Am,2004,35(3):265-271.
20 李峻辉,宁亚功,叶建红,等.激素性股骨头坏死家兔血液流变学及血脂观察[J].云南医药,2003,24(2):82-84.
21 姚永东,王国毓,杨毓华,等.激素性股骨头坏死动物血液流变学的观察[J].中医正骨,2000,12(4):6-7.
22 胡长根,陈君长,刘强,等.激素对股骨头微血管及组织细胞的影响[J].中华骨科杂志,2004,24(6):359.
23 李月白.激素诱导骨髓基质细胞成脂分化的实验研究[J].中华骨科杂志,1999,19(11):687-689.
24 王昊,周金水.激素性股骨头缺血性坏死的病理研究进展[J].现代中西医结合杂志,2005,14(23):3184-86
25 Cui Q,Wang CJ,Balian C.Steroid-induced adipogenesis pluripotential cell line fi-om bone marrow[J].J Bone Joint Surg(Am),1997,79:1054-63.
26 Oreffo RO,Virdi AS,Triffiu JT.Modulation of osteogenesis and adipogenesis by human serum m human bone Marrow cultrues[J].Eur J Cell Biol,1997,74:251-261.
27 薛元锁,时述山,李亚非,等.激素性股骨头坏死病程中骨形态发生蛋白-2的改变及其意义[J].中华实验外科杂志,2000,17(5):455.
28 Weinstein RS,Jilka R.L,Parfitt AM,et al.Inhibition of osteoblastogenesis and promotion of apoptosis of osteoblasts and osteoeytes by glucecortieoids.Potential mechanisms of their deleterious elects on bone[J].J Clin Invest,1998,102(2):274-282.
29 Hofbauer LC,Gorl F,Riggs BL,et al.Stimulation of osteoprotegerin ligand and inhibition of osteoprotegerin production by glucoeortieoids in human osteoblastic lineage cells:potential paracrine mechanisms of glucocorticoid-induced osteopomsis[J].Endocrinologi,1999,140:4382-4389.
30 Wang G J,Cui Q,Balian G.The pathogenesis and prevention of steroid-reduced osteonecrosis[J].Clin Orthop,2000,370:295-310.
31 Hemigou P,Beaujean F,Lambotte JC.Decrease in the mesenehymal stem cell pool in the proximal femur in corticosteroid-induced osteoneerosis[J].J Bone Joint Surg Bt,1999,81(2):349-355.
32 Li X,Jin L,Cui Q,et al.Steroid effects on osteogenesis through mesenchymal cel gene expression[J].Osteoporos Int,2004,15:1.
33 Asano T,Takahashi KA,Fujioka M,et al.ABCB1 C3435T and G2677T / A polymorphism decreased the risk for steroid-induced osteonecrosis of the femoral head after kidney transplantation[J].Pharmaeogenetics,2003,13(11):675-682.
34 Lieberma JR,Berry DJ,Mont MA,et al.Osteonecrosis of the hip:managemem in the 21st century[J].Instr Course Leer,2003,52:337-355.
35 Celik A,Tekis D,Saglam F,et al.Association of corticosteroids and factor V,prothrombin,and MTHFR gene mutations with avascular osteonecrosis in renal allagraft recipients[J].Transplant Proc,2006,38:512-516.
36 Zalavras CG,Vartholomatos G,Dokou E,et al.Factor V Leiden and prothrombin gene mutations in femoral head osteonecrosis[J].Thromb Haemost,2002,87:1079-1080.
37 Liu YF,Chen WM,Lin YF,et al.Type Ⅱ collagen gene variants and inherited osteoneerosis of the femoral head[J].N Engl J Med,2005,352:2294-2301.
38 Proekop DJ.Type Ⅱ collagen and avascular necrosis of the femoral head[J].N Ensl J Med,2005,352:2268-2270.
39 Chen WP,Tai CL,Tan CF,et al.The degrees to which transtrochanteric rotational osteotomy moves the region of osteonecrotic femoral head out of the weight-bearing area as evaluated by computer simulation[J].Clin Biomech(Bristol,Avon),2005,20(1):63-9.
40 M.Kumagai,Y.H.Kim,N.Inoue,et al.3-D Dynamic Hip Contact Pressure Distribution In Daily Activities[J].2003 Summer Bioengineering Conference,June 25-29,Sonesta Beach Resort in Key Biscayne,Florida,2003.
41 Yoshida H,Faust A,Wilckens J,et al.Three-dimensional dynamic hip contact area and pressure distribution during activities of daily living[J].J Biomech,2006,39(11):1996-2004.
42 Harnroongroj T.The role of the anterior column of the acetabulum on pelvic stability:a biomechanical study[J].Injury,1998,29:293-6.
43 裘世静.正常股骨头骨小梁的拱结构特征及其生物力学意义[J].中华外科杂志,1991,29(8):487.
44 俞超,薛文东,张双燕,等.股骨头负重区松质骨的压缩力学特性[J].上海生物医学工程杂志,2004.25(1):22.
45 赵宝林,程杰平,马洪顺,等.股骨头松质骨力学性质实验研究[J].医用生物力学,2003,18(4):234.
46 杨善卿.单髓负重的生物力学探讨[J].生物力学,1990,5(7):92.
47 Genda E,Iwasaki N,Li G,et al.Normal hip joint contact pressure distribution in single-leg standing-effect of gender and anatomic parameters[J].J Biomeeh,2001,34(7):895-905.
48 高士濂.实用解剖图谱[M].上海科学技术出版社,2004:358-363.
49 Letoumel E.Acetabulum fractures:classification and management[J].Clin Orthop Relat Res,1980:81-106.
50 Matta JM,Anderson LM,Epstein HC,et al.Fractures of the acetabulum.A retrospective analysis[J].Clin Orthop Relat Res,1986,205(6):230-40.
51 KNIGHT RA,SMITH H.Central fractures of the acetabuhim[J].J Bone Joint Surg Am,1958,40-A(1):1-16 passim.
52 von Eisenhart R,Adam C,Steinlechner M,et al.Quantitative determination of joint incongruity and pressure distribution during simulated gait and cartilage thickness in the human hip joint[J].J Orthop Res,1999,17(4):532-9.
53 Brown TD,Way ME,Ferguson AB Jr.Mechanical characteristics of bone in femoral capital aseptic necrosis[J].Clin Orthop Relat Res,1981:240-7.
54 Kim YM,Lee SH,Lee FY,et al.Morphologic and biomechanical study of avascular necrosis of the femoral head[J].Orthopedics,1991,14:1111-6.
55 王金熙,董天华,陈贤志,等.实验性股骨头缺血性坏死修复过程的生物力学研究[J].中华外科杂志,1993,31(6):374.
56 Magnussen RA,Guilak F,Vail TP.Cartilage degeneration in post-collapse cases of osteonecrosis of the human femoral head:altered mechanical properties in tension,compression,and shear[J].J Orthop Res,2005,23:576-83.
57 Brown TD,Mutschler TA,Ferguson AB Jr.A non-linear finite element analysis of some early collapse processes in femoral head osteonecrosis[J].J Biomech,1982,15:705-15.
58 Ueo T,Tsutsumi S,Yamamuro T,et al.Biomechanical aspects of the development of aseptic necrosis of the femoral head[J].Arch Orthop Trauma Surg,1985,104:145-9.
59 Brown TD,Baker KJ,Brand RA.Structural consequences of subchondral bone involvement in segmental osteonecrosis of the femoral head[J].J Orthop R.es,1992,10:79-87.
60 Van Rietbergen B,Muller R,Ulrich D,et al.Tissue stresses and strain in trabeculae of a canine proximal femur can be quantified from computer reconstructions[J].J Biomech,1999,32:443-51.
61 Yang JW,Koo KH,Lee MC,et al.Mechanics of femoral head osteonecrosis using three-dimensional finite element method[J].Arch Orthop Trauma Surg,2002,122(2):88-92.
62 Daniel M,Herman S,Dolinar D,et al.Contact stress in hips with osteonecrosis of the femoral head[J].Clin Orthop Relat Res,2006,447:92-9.
63 王伟,刘朋,等.成人股骨头坏死塌陷的发病机理及诊治进展[J].医学信息:医学与计算机应用,2000,13(12):696-8.
64 Brown TD,Mutsehler TA,Ferguson AB Jr.A non-linear finite element analysis of some early collapse processes in femoral head osteoneerosis[J].J Biomech,1982,15:705-15.
65 Mont MA,Jones LC,Einhorn TA,et al.Osteonecrosis of the femoral head.Potential treatment with growth and differentiation factors[J].Clin Orthop Relat Res,1998:S314-35.
66 张永飞,张义修.股骨颈骨折术后股骨头坏死的力学因素[J].骨与关节损伤杂志,2001,16(4):270.
67 Kerboul M,Thomine J,Postel M,et al.The conservative surgical treatment of idiopathic aseptic necrosis of the femoral head[J].J Bone Joint Surg Br,1974,56:291-6.
68 Steinberg ME,Bands RE,Parry S,et al.Does lesion size affect the outcome in avascular necrosis?[J].Clin Orthop Relat Res,1999:262-71.
69 Ohzono K,Saito M,Takaoka K,et al.Natural history of nontraumatic avascular necrosis of the femoral head[J].J Bone Joint Surg Br,1991,73:68-72.
70 Sugano N,Takaoka K,Ohzono K,et al.Prognostication of nontraumatic avascular necrosis of the femoral head.Significance of location and size of the necrotic lesion[J].Clin Orthop Relat Res,1994:155-64.
71 Kokubo T,Takatori Y,Ninomiya S,et al.Magnetic resonance imaging and scintigraphy of avascular necrosis of the femoral head.Prediction of subsequent segmental collapse[J].Clin Orthop Relat Res,1992:54-60.
72 Takatori Y,Kokubo T,Ninomiya S,et al.Avascular necrosis of the femoral head.Natural history and magnetic resonance imaging[J].J Bone Joint Surg Br,1993,75:217-21.
73 Iwasada S,Hasegawa Y,Iwase T,et al.Bone scintigraphy and magnetic resonance imaging after transtroehanteric rotational osteotomy[J].Skeletal Radiol,1999,28:251-9.
74 Bassett LW,Mirra JM,Cracehiolo A 3rd,et al.Isehemic necrosis of the femoral head.Correlation of magnetic resonance imaging and histologic sections[J].Clin Orthop Relat Res,1987:181-7.
75 王刚,赵国库,张新,等.股骨头缺血性坏死的磁共振影像与骨小梁强度分析[J].中华医学杂志,1998,78(6):467-9.
76 张新,王刚,孙磊,等.非创伤性股骨头缺血性坏死的磁共振影像与多平面骨组织计量学的对照研究[J].白求恩医科大学学报,1998,24(4):423-4.
77 Beltran J,Knight CT,Zuelzer WA,et al.Core decompression for avascular necrosis of the femoral head:correlation between long-term results and preoperative MR staging[J].Radiology,1990,175:533-6.
78 Sugano N,Ohzono K,Masuhara K,et al.Prognostication of osteonecrosis of the femoral head in patients with systemic lupus erythematosus by magnetic resonance imaging[J].Clin Orthop Relat Res,1994:190-9.
79 Kubo T,Yamazoe S,Sugano N,et al.Initial MRI fmdings of non-traumatic osteonecrosis of the femoral head in renal allograft recipients[J].Magn Reson Imaging,1997,15:1017-23.
80 Shimizu K,Moriya H,Akita T,et al.Prediction of collapse with magnetic resonance imaging of avaseular necrosis of the femoral head[J].J Bone Joint Surg Am,1994,76:215-23.
81 Sakamoto M,Shimizu K,Iida S,et al.Osteonecrosis of the femoral head:a prospective study with MRI[J].J Bone Joint Surg Br,1997,79:213-9.
82 Ito H,Matsuno T,Kaneda K.Prognosis of early stage avascular necrosis of the femoral head[J].Clin Orthop Relat Res,1999:149-57.
83 Lafforgne P,Dahan E,Chagnaud C,et al.Early-stage avascular necrosis of the femoral head:MR imaging for prognosis m 31 cases with at least 2 years of follow-up[J].Radiology,1993,187:199-204.
84 Koo KH,Kim R.Quantifying the extent of osteonecrosis of the femoral head.A new method using MRI[J].J Bone Joint Surg Br,1995,77:875-80.
85 赵凤朝,李子荣,张念非,等.坏死面积比例在预测股骨头塌陷中的价值[J].中华骨科杂志,2005.25(9):520-3.
86 Cherian SF,Laorr A,Saleh KJ,et al.Quantifying the extent of femoral head involvement in osteonecrosis[J].J Bone Joint Surg Am,2003,85-A:309-15.
87 Nishii T,Sugano N,Ohzono K,et al.Significance of lesion size and location m the prediction of collapse of osteonecrosis of the femoral head:a new three-dimensional quantification using magnetic resonance imaging[J].J Orthop Res,2002,20:130-6.
88 Hemigou P,Lambotte JC.Volumetric analysis of osteonecrosis of the femur.Anatomical correlation using MRI[J].J Bone Joint Surg Br,2001,83:672-5.
89 Penix AR,Cook SD,Skinner HB,et al.Femoral head stresses following cortical hone grafting for aseptic necrosis.A finite element study[J].Clin Orthop Relat Res,1983,(173):159-65.
90 Brown TD,Pedersen DR,Baker KJ,et al.Mechanical consequences of core drilling and bone-grafting on osteonecrosis of the femoral head[J].J Bone Joint Surg Am,1993,75(9):1358-67.
91 Sakamoto J,Brown TD.Toward determining construct mechanical optimality for fibular bone grafting in femoral head osteonecrosis[J].Iowa Orthop J,1996,16:79-87.
92 Nagoya S,Nagao M,Takada J,et al.Predictive factors for vascularized iliac bone graft for nontraumatic osteonecrosis of the femoral head[J].J Orthop Sci,2004,9(6):566-70.
93 Hofmann S,Mazieres B.Osteonecrosis:natural course and conservative therapy[J].Orthopade,2000,29:403-10.
94 Garino JP,Steinberg ME.Total hip arthroplasty in patients with avascular necrosis of the femoral head:a 2- to 10-year follow=up[J].Clin Orthop Relat Res,1997:108-15.
95 刘少军.王海彬,袁浩.生脉成骨片对早期股骨头坏死塌陷的影响[J].新中医,2007,33(9):49-52.
96 Cui Q,Wang G J,Su CC,et al.The Otto Aufranc Award.Lovastatin prevents steroid induced adipogenesis and osteonecrosis[J].Clin Orthop Relat Res,1997:8-19.
97 Pritchett JW.Statin therapy decreases the risk of osteonecrosis in patients receiving steroids[J].Clin Orthop Relat Res,2001:173-8.
98 Wang G J,Cui Q,Balian G.The Nicolas Andry award.The pathogenesis and prevention of steroid-induced osteonecrosis[J].Clin Orthop Relat Res,2000:295-310.
99 Li X,Jin L,Cui Q,et al.Steroid effects on osteogenesis through mesenchymal cell gene expression[J].Osteoporos Int,2005,16:101-8.
100 王卫东,廖文胜,王义生.辛伐他汀预防激素性股骨头坏死的实验研究[J].郑州大学学报(医学版),2004,39(3):473-5.
101 Maruno H,Shimizu T,Kawai K,et al.The response of osteocytes to a lipid clearing agent in steroid-treated rabbits[J].J Bone Joint Surg Br,1991,73:911-5.
102 周谋望,秦建中,刘志雄,等.降脂药物防治激素所致股骨头骨细胞损害的实验研究[J].中华医学杂志,1996,76(1):13-6.
103 Masuhara K,Nakata K,Yamasaki S,et al.Involvement of platelet activation in experimental osteonecrosis in rabbits[J].Int J Exp Fathol,2001,82:303-8.
104 刘万林,郭文通,李文琪,等.抗凝改善骨内微循环治疗激素性股骨头缺血性坏死的初步观察[J].内蒙古医学院学报,1999,21(4):235-6.
105 廖文胜,王义生,高远,等.激素性股骨头坏死发病机制及藻酸双酯钠的干预作用[J].河南医药信息,2001,9(10):1-3.
106 李卫哲,李景南,张新.抗凝药物预防激素所致股骨头坏死[J].吉林大学学报(医学版),2003,29(4):475-476.
107 Glueck CJ,Freiberg RA,Wang P.Role of thrombosis in osteonecrosis[J].Curr Hematol Rep,2003,2:417-22.
108 Norman D,Miller Y,Sabo E,et al.The effects of enoxaparin on the reparative processes in experimental osteoneerosis of the femoral head of the rat[J].APMIS,2002,110:221-8.
109 Reis ND,Schwartz O,Militianu D,et al.Hyperbaric oxygen therapy as a treatment for stage-I avascular necrosis of the femoral head[J].J Bone Joint Surg Br,2003,85:371-5.
110 陈卓明,程秀萍,张岷波,等.高压低频脉冲直流电治疗股骨头缺血性坏死临床观察[J].中国疗养医学,2002,11(2):10-1.
111 韩永台,米立新,李欣,等.分米波治疗股骨头缺血性坏死[J].中华理疗杂志,1999,22(2):72-4.
112 Russo S,Galasso O,Gigliotti S,et al.Shockwave treatment for osteonecrosis of the hip.Musculoskeletal shockwave therapy[J].1 st ed ed.London:Greenwich Medical Ltd,2000.231-40.
113 曹殿波,杨海山,赵永生,等.成人股骨头缺血坏死介入治疗的临床疗效分析[J].白求恩医科大学学报,2001,27(5):529-31.
114 李喜东.介入治疗激素性股骨头坏死的实验研究[J].中华放射学杂志,1998,32(1):32-5.
115 权毅.股骨头缺血坏死介入治疗的临床观察[J].骨与关节损伤杂志,2001,16(5):336-8.
116 Hungerford DS.Early diagnosis of ischemic necrosis of the femoral head[J].Johns Hopkins Med J,1975,137:270-5.
117 Ficat RP.Idiopathic bone necrosis of the femoral head.Early diagnosis and treatment[J].J Bone Joint Surg Br,1985,67:3-9.
118 李毅中,乐铜.特发性股骨头坏死的诊断与治疗[J].中华外科杂志,1989,6:337-341.
119 郑召民,许振华.骨内压研究的进展[J].河南医学研究,1995,4:190-192.
120 Wilkes CH,Visscher MB.Some physiological aspects of bone marrow pressure[J].J Bone Joint Surg Am,1975,57:49-57.
121 张毓洲,许露玫,许振华,等.正常与骨内高压下骨髓微循环冷冻割断扫描电镜观察[J].中华骨科杂志,1999,19:303-5.
122 和树政,许振华,刘保民.骨内高压下骨微循环形态扫描电镜观察[J].中华骨科杂志,1990,11:215-218.
123 Chan TW,Dalinka MK,Steinberg ME,et al.MRI appearance of femoral head osteonecrosis following core decompression and bone grafting[J].Skeletal Radiol,1991,20:103-7.
124 Plenk H Jr,Gstettner M,Grossschrnidt K,et al.Magnetic resonance imaging and histology of repair in femoral head osteonecrosis[J].Clin Orthop Relat Res,2001:42-53.
125 Aigner N,Schneider W,Ebed V,et al.Core decompression in early stages of femoral head osteonecrosis-an MRI-controlled study[J],hat Orthop,2002,26:31-5.
126 Specchiulli F.Core decompression in the treatment of necrosis of the femoral head.Long-term results[J].Chit Organi Mov,2000,85:395-402.
127 Mont MA,Carbone JJ,Fairbank AC.Core decompression versus nonoperative management for osteonecrosis of the hip[J].Clin Orthop Relat Res,1996:169-78.
128 Steinberg ME,Larcom PG,Stratford B,et al.Core decompression with bone grafting for osteonecrosis of the femoral head[J].Clin Orthop Relat Res,2001:71-8.
129 Yoon TR,Song EK,Rowe SM,et al.Failure after core decompression in osteonecrosis of the femoral head[J],hat Orthop,2001,24:316-8.
130 Camp JF,Colwell CW Jr.Core decompression of the femoral head for osteonecrosis[J].J Bone Joint Surg Am,1986,68:1313-9.
131 Simank HG,G-raf J,Kerber A,et al.Long-term effects of core decompression by drilling.Demonstration of bone healing and vessel ingrowth in an animal study.[J]Acta Anat(Basel),1997,158:185-91.
132 Chang MC,Chen TH,Lo WH.Core decompression in treating ischemic necrosis of the femoral head[J].Zhonghua Yi Xue Za Zhi(Taipei),1997,60:130-6.
133 Castro FP Jr,Barrack RL.Core decompression and conservative treatment for avascular necrosis of the femoral head:a meta-analysis[J].Am J Orthop,2000,29:187-94.
134 Soucacos PN,Beris AE,Malizos K,et al.Treatment of avascular necrosis of the femoral head with vascularized fibular transplant[J].Clin Orthop Relat Res,2001:120-30.
135 Leali A,Fetto J,Hale JJ.Biostructural augmentation for the treatment of osteonecrosis:rationale,technique,and case example[J].J South Orthop Assoc,2002,11:167-71.
136 Berend KR,Gunneson EE,Urbaniak JP,..Free vascularized fibular grafting for the treatment of postcollapse osteonecrosis of the femoral head[J].J Bone Joint Surg Am,2003,85-A:987-93.
137 Lieberman JR.Core decompression for osteonecrosis of the hip[J].Clin Orthop Relat Res,2004:29-33.
138 Gonzalez Della Valle A,Bates J,Di Carlo E,et al.Failure of free vascularized fibular graft for osteonecrosis of the femoral head:a histopathologic study of 6 cases[J].J Arthroplasty,2005,20:331-6.
139 梅荣成,杨述华,杨操,等.钛合金支撑架结合自体骨和DBM治疗股骨头坏死[J].中国矫形外科杂志,2006,14(7):509-11.
140 何伟,袁浩,李雄,等.多条血管束植入治疗成人股骨头坏死的远期疗效观察[J].骨与关节损伤杂志,2000,15(4):261-2.
141 范丽娟,苏奇,余焕群.多组血管束植入股骨头修整与再造治疗中晚期股骨头缺血性坏死[J].骨与关节损伤杂志,2003,18(9):596-7.
142 Mont MA,Einhom TA,Sponseller PD,et al.The trapdoor procedure using autogcnous cortical and cancellous bone grafts for osteonecrosis of the femoral hcad[J].J Bone Joint Surg Br,1998,80:56-62.
143 曾述强,张功林,葛宝丰,等.经股骨头开瓣植骨术治疗股骨头缺血性坏死[J].中国骨伤,2002,15(12):710-11.
144 杨旭东.介入+异体腓骨移植治疗成人股骨头缺血性坏死[J].临床骨科杂志,2003,6(4):327-9.
145 Hemigou P,Bachir D,Galacteros F.Avascular necrosis of the femoral head in sickle-cell disease.Treatment of collapse by the injection of acrylic cement[J].J Bone Joint Surg Br,1993,75:875-80.
146 Wood ML,McDowell CM,Kerstcttcr TL,et al.Open reduction and cementation for femoral head fracture secondary to avascular necrosis:preliminary report[J].Iowa Orthop J,2000,20:17-23.
147 董天华,刘松,朱国梁,等.羟基磷灰石骨水泥植入治疗成人股骨头缺血性坏死的中期疗效观察[J].中华骨科杂志,2002,22(2):84-87.
148 Jones JP Jr.Alcoholism,hypercortisonism,fat embolism and osseous avascular necrosis[J].Clin Orthop Relat Rcs,2001:4-12.
149 周华江,聂林,张琦,等.碱性成纤维细胞因子对兔股骨头坏死模型实验修复过程的影响[J].中国矫形外科杂志,2002,10(9):895-7.
150 杨操,杨述华,杜靖远,等.bFCF基因转染促进股骨头坏死修复的实验研究[J].中国矫形外科杂志,2004,12(16):1236-1239.
151 Yang C,Yang S,Du J,et al.Vascular endothelial growth factor gene transfection to enhance the repair of avaseular necrosis of the femoral head of rabbit[J].Chin Med J(Engl),2003,116:1544-8.
152 周强,石国华,杨柳,等.复合多孔生物材料在股骨头坏死模型中诱导成骨的观察[J].中华外科杂志,2002,40(6):458-61.
153 周华江,薛强,张琦,等.重组合异种骨治疗股骨头缺血坏死的实验研究[J].中华实验外科杂志, 2004,21(9):1148.
154 Mont MA,Jones LC,Elias JJ,et al.Strut-autografting with and without osteogenic protein-1:a preliminary study of a canine femoral head defect model[J].J Bone Joint Surg Am,2001,83-A:1013-22.
155 Lieberman JR.,Conduah A,Urist MR.Treatment of osteonecrosis of the femoral head with core decompression and human bone morphogenetic protein[J].Clin Orthop Relat Res,2004:139-45.
156 Simank HG,Manggold J,Sebald W,et al.Bone morphogenetic protein-2 and growth and differentiation factor-5 enhance the healing of necrotic bone in a sheep model[J].Growth Factors,2001,19:247-57.
157 李建军,韩东,刘建国,等.BMP-2重组质粒转染人骨髓基质干细胞及表达蛋白的诱导活性观察[J].中华创伤骨科杂志,2004,6(2):190-193.
158 Mont MA,Etienne G,Ragland PS.Outcome of nonvascularized bone grafting for osteonecrosis of the femoral head[J].Clin Otthop Relat Res,2003:84-92.
159 Breitbart AS,Grande DA,Kessler R,et al.Tissue engineered bone repair of calvarial defects using cultured periosteal cells[J].Hast Reconstr Surg,1998,101:567-74;discussion 575-6.
160 徐小良,王坤正,杨增华,等.bBMP-胶元-珊瑚复合人工骨修复股骨头缺损的生物力学研究[J].中国骨伤,2001,14(1):17-9.
161 孙庆仲,闫红艳,郭文希,等.牛脱蛋白松质骨、胶原、BMP、RBM复合物修复骨缺损的实验研究[J].骨与关节损伤杂志,2002,17(6):433-5.
162 尹庆水,张余,李兆麟,等.复合珊瑚羟基磷灰石人工骨的研制和临床应用[J].骨与关节损伤杂志,2003,18(3):147-9.
163 李亚非,常红星,姚建华,等.组织工程化异体骨复合物BMP和自体骨髓治疗股骨头缺血性坏死[J].中华骨科杂志,2005,25(6):337-41.
164 朱盛修.股骨头缺血坏死的显微外科治疗进展[J].中华显微外科杂志,2000,23(4):245-6.
165 Judet H,Gilbert A.Long-term results of free vaseularized fibular grafting for femoral head necrosis[J].Clin Orthop Relat Res,2001:114-9.
166 Urbaniak JR,Coogan PG,Gunneson EB,et al.Treatment of osteonecrosis of the femoral head with free vaseularized fibular grafting.A long-term follow-up study of one hundred and three hips[J].J Bone Joint Surg Am,1995,77:681-94.
167 Urbaniak JR,Harvey EJ.Revascularization of the femoral head in osteonecrosis[J].J Am Aead Orthop Surg,1998,6:44-54.
168 王坤正,同志勤,王春生,等.吻合血管游离腓骨移植治疗股骨头坏死[J].中华显微外科杂志,2000,23(4):254-256.
169 Vail TP,Urbaniak JR.Donor-site morbidity with use of vascularized autogenous fibular grafts[J].J Bone Joint Surg Am,1996,78:204-11.
170 陈振光.带血管蒂股骨大转子骨瓣移植术[J].中华显微外科杂志,1996,19:232.
171 赵德伟,王卫明,王本杰,等.保留股骨头手术治疗股骨头缺血性坏死1005例临床分析[J].中华外科杂志,2005,43(16):1054-7.
172 范启申,周祥吉,周建国,等.成人重度股骨头缺血性坏死显微手术方法的选择[J].中华显微外科杂志,1998,21(1):6-8.
173 赵林,侍德,张其恭.缺血性骨坏死治疗方法比较的实验研究[J].中华外科杂志,1991,20:72.
174 Sugioka Y,Hotokebuchi T,Tsutsui H.Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head.Indications and long-term results[J].Clin Orthop Relat Res,1992:111-20.
175 Mont MA,Fairbank AC,Krackow KA,et al.Corrective osteotomy for osteonecrosis of the femoral head[J].J Bone Joint Surg Am,1996,78:1032-8.
176 Schneider W,Aigner N,Pinggera O,et al.Intertrochanteric osteotomy for avascular necrosis of the head of the femur.Survival probability of two different methods[J].J Bone Joint Surg Br,2002,84:817-24.
177 Onodera S,Majima T,Abe Y,et al.Transtrochanteric rotational osteotomy for osteonecrosis of the femoral head:relation between radiographic features and secondary collapse[J].J Orthop Sci,2005,10:367-73.
178 Nakamura Y,Kumazawa Y,Mitsui H,et al.Combined rotational osteotomy and vascularized iliac bone graft for advanced osteonecrosis of the femoral head[J].J Reconstr Microsurg,2005,21:101-5.
179 Dean MT,Cabanela ME.Transtrochanteric anterior rotational osteotomy for avascular necrosis of the femoral head.Long-term results[J].J Bone Joint Surg Br,1993,75:597-601.
180 邓沂,张晓刚,任远,等.中医对股骨头坏死的认识[J].甘肃中医学院报,1988,15(4):54-6.
181 郭效东,陈卫衡,赵永刚,等.股骨头无菌性坏死三期辩证论治的临床研究(附50倒报告).北京:全国股骨头无菌性坏死学术研讨会论文汇编,1992:310-313.
182 李宇明.袁浩教授治疗股骨头缺血性坏死的学术思想和经验.全国股骨头无菌性坏死学术研讨会论文汇编(北京),1999:11.
183 威新开,藏红亚.桂枝芍药知母汤加味治疗股骨头坏死[J].现代中西医结合杂志,2002,11(17):1695-6.
184 刘少军,袁浩.股骨头坏死的中医临床思路与方法探讨[J].中国医药学报,2002,17(1):44-7.
185 齐振熙,曹阳.不同治法对激素性股骨头坏死血液流变学及血脂影响的实验研究[J].中国中医骨伤科杂志,2001,9(5):30-1.
186 洪加源,许书亮,阮景绰,等.复元散对激素性股骨头环死脂代谢的影响[J].中医正骨,2001,13(4):6-8.
187 张晓刚,任远,王钢,等.生骨散对激素性股骨头坏死家兔血脂的影响[J].2001,14(3):148-9.
188 徐传毅.袁浩教授以血瘀论治激素性股骨头坏死经验[J].中医药学刊,2003,21(2):194-5.
189 陈卫衡,刘道兵,张洪美等.股骨头坏死的三期四型辨证思路[J].中国中医基础医学杂志,2003,9(12):51-2.
190 王峰,丁锷,李保泉.股骨头缺血性坏死的中医分型和治疗[J].中医正骨,2005,17(7):23-4.
191 王萍,高红艳.辨证分型治疗激素性股骨头坏死117例[J].上海中医药大学学报,2003,17(1):36-7.
192 胡心愿,全健,刘英纯.浅淡股骨头坏死的中医三期论治.陕西中医,2006,27(3):314-315.
1 Ohzono K,Saito M,Takaoka K,et al.Natural history of nontraumatic avascular necrosis of the femoral head[J].J Bone Joint Surg Br,1991,73(1):68-72.
2 Sugano N,Atsumi T,Ohzono K,et al.The 2001 revised criteria for diagnosis,classification,and staging of idiopathic osteonecrosis of the femoral head[J].J Orthop Sci,2002,7(5):601-5.
3 Sugano N,Takaoka K,Ohzono K,et al.Prognostication of nontraumatic avascular necrosis of the femoral head.Significance of location and size of the necrotic lesion[J].Clin Orthop Relat Res,1994,303:155-64.
4 高扬,王俊勤,陈伯华.单侧髋关节蛙式位透视在股骨颈骨折内固定手术中的应用及相关问题探讨[J].生物骨科材料与临床研究,2007,4(5):38-40.
5 M.Kumagai,Y.H.Kim,N.Inoue,et al.3-D Dynamic Hip Contact Pressure Distribution In Daily Activities[J].2003 Summer Bioengineering Conference,June 25-29,Sonesta Beach Resort in Key Biscayne,Florida,2003.
6 Yoshida H,Faust A,Wilckens J,et al.Three-dimensional dynamic hip contact area and pressure distribution during activities of daily living[J].J Biomech,2006,39(11):1996-2004.
7 Chen WP,Tai CL,Tan CF,et al.The degrees to which transtrochanteric rotational osteotomy moves the region of osteonecrotic femoral head out of the weight-bearing area as evaluated by computer simulation[J].Clin Biomech(Bristol,Avon),2005,20(1):63-9.
8 Langlais F,Fourastier J.Rotation osteotomies for osteonecrosis of the femoral head[J].Clin Orthop Relat Res,1997,343(10):110-23.
9 Genda E,Iwasaki N,Li G,et al.Normal hip joint contact pressure distribution in single-leg standing—effect of gender and anatomic parameters[J].J Biomech,2001,34(7):895-905.
10 杨善卿.单髓负重的生物力学探讨[J].生物力学,1990,5(7):92.
11 Matta JM,Anderson LM,Epstein HC,et al.Fractures of the acetabulum.A retrospective analysis[J].Clin Orthop Relat Res,1986,205(6):230-40.
12 Yang JW,Koo KH,Lee MC,et al.Mechanics of femoral head osteoneerosis using three-dimensional finite element method[J].Arch Orthop Trauma Surg,2002,122(2):88-92.
13 Daniel M,Herman S,Dolinar D,et al.Contact stress in hips with osteonecrosis of the femoral head[J].Clin Orthop Relat Res,2006,447:92-9.
14 李子荣.股骨头坏死诊断与治疗的专家建议[J].中华骨科杂志,2007,27(2):146-8.
15 Cherian SF,Laorr A,Saleh KJ,et al.Quantifying the extent of femoral head involvement in osteonecrosis[J].J Bone Joint Surg Am,2003,85-A(2):309-15.
16 Takashi Nishii,MD,Nobuhiko Sugano,MD,Kenji Ohzono,MD,et al.Progression and Cessation of Collapse in Osteonecrosis of the Femoral Head[J].Clin Orthop Relat Res,2002,400:149-157.
17 赵培荣,庄奇新,乔瑞华,等.股骨头缺血坏死骨髓水肿的MRI研究[J].实用放射学杂志,2006,22(7):835-7.
18 Moss SG,Schweitzer ME,Jacobson JA,ctal.Hip joint fluid:detection and distribution at MR imaging and US with cadaveric correlation[J].Radiology,1998,208(1):43-8.
19 南登昆,缪鸿石.康复医学[M].北京:人民卫生出版社,1993,95.
20 郝延科,刘祖振,等.审校:张世华.股骨头坏死的早期影像学诊断[J].中国中西医结合影像学杂志,2004,2(3):232-4.
21 马在松综述,史振满审校.早期股骨头坏死的诊断及鉴别诊断[J].中国矫形外科杂志,2001,8(5):503-5.
22 李常山.股骨头缺血坏死的影像学诊断[J].山东医药,2006,46(34):81-2.
23 王岩,朱盛修.成人股骨头缺血性坏死的治疗与疗效评价法[J].解放军医学杂志,1998,23(1):77-8.
24 Brown TD,Pedersen DR,Baker KJ,et al.Mechanical consequences of core drilling and bone-grafting on osteonecrosis of the femoral head[J].J Bone Joint Surg Am,1993,75(9):1358-67.
25 Penix AR,Cook SD,Skinner HB,et al.Femoral head stresses following cortical bone grafting for aseptic necrosis.A finite element study[J].Clin Orthop Relat Res,1983,(173):159-65.
26 Sakamoto J,Brown TD.Toward determining construct mechanical optimality for fibular bone grafting in femoral head osteonecrosis[J].Iowa Orthop J,1996,16:79-87.
27 Nagoya S,Nagao M,Takada J,et al.Predictive factors for vascularized iliac bone graft for nontraurnatic osteonecrosis of the femoral head[J].J Orthop Sci,2004,9(6):566-70.
28 王伟,刘朋,等.成人股骨头坏死塌陷的发病机理及诊治进展[J].医学信息:医学与计算机应用,2000,13(12):696-8.
29 刘少军,袁浩.股骨头坏死的中医临床思路与方法探讨[J].中国医药学报,2002,17(1):44-7.
30 陈卫衡,刘道兵,张洪美等.股骨头坏死的三期四型辨证思路[J].中国中医基础医学杂志,2003,9(12):51-2.