Glucocorticoid-induced avascular bone necrosis: diagnosis and management.
Glucocorticoid-induced avascular bone necrosis: diagnosis and management.
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DOI：
10.2174/1874325001206010449
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发表时间：
2012-01-01
期刊：
影响因子：
--
通讯作者：
Mok, C C
中科院分区：
文献类型：
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作者：
Chan, K L;Mok, C C
糖皮质激素的使用是导致缺血性骨坏死（AVN）的重要原因之一。糖皮质激素诱导的AVN的发病机制还不完全清楚，但假设的机制包括脂肪肥大、脂肪栓塞和血管内凝血，导致骨骼血液供应阻抗。关于AVN与糖皮质激素剂量、给药途径和治疗持续时间之间关系的数据相互矛盾，一些研究表明糖皮质激素的累积剂量是最重要的决定因素。早期识别这种并发症是必不可少的，因为预后受疾病阶段的影响。目前，对于是否应该对长期糖皮质激素使用者进行无症状AVN的普遍筛查还没有达成共识。对于典型部位的骨和关节疼痛，应高度怀疑。磁共振成像（MRI）或骨显像对诊断早期AVN较X线平片敏感。AVN的保守治疗包括休息和减轻负重。如果基础条件允许，应考虑最小化糖皮质激素剂量或完全停药。双膦酸盐在降低股骨头塌陷发生率方面的疗效存在争议。手术治疗包括髓芯减压、截骨、植骨和关节置换。近年来，在治疗AVN方面取得了一些进展，包括钽棒的使用和髋关节置换术中更耐磨的关节面的开发。
Glucocorticoid use is one of the most important causes of avascular bone necrosis (AVN). The pathogenesis of glucocorticoid-induced AVN is not fully understood but postulated mechanisms include fat hypertrophy, fat emboli and intravascular coagulation that cause impedance of blood supply to the bones. Data regarding the relationship between AVN and dosage, route of administration and treatment duration of glucocorticoids are conflicting, with some studies demonstrating the cumulative dose of glucocorticoid being the most important determining factor. Early recognition of this complication is essential as the prognosis is affected by the stage of the disease. Currently, there is no consensus on whether universal screening of asymptomatic AVN should be performed for long-term glucocorticoid users. A high index of suspicion should be exhibited for bone and joint pain at typical sites. Magnetic resonance imaging (MRI) or bone scintigraphy is more sensitive than plain radiograph for diagnosing early-stage AVN. Conservative management of AVN includes rest and reduction of weight bearing. Minimization of glucocorticoid dose or a complete withdrawal of the drug should be considered if the underlying conditions allow. The efficacy of bisphosphonates in reducing the rate of collapse of femoral head in AVN is controversial. Surgical therapy of AVN includes core decompression, osteotomy, bone grafting and joint replacement. Recent advances in the treatment of AVN include the use of tantalum rod and the development of more wear resistant bearing surface in hip arthroplasty.