来源：304关节学术

译者：罗殿中

整理：骨科在线

一篇发表于《Chin Med J (Engl)》杂志的文章通过对不同时期股骨头坏死的临床症状、体征、影像学表现的评价进行研究，对多种保髋手术预后的评价进行分析，回顾了股骨头坏死围塌陷期的诊断和治疗价值。

围塌陷期指股骨头坏死出现软骨下骨折到早期塌陷（<2mm）的连续时期，具有特殊的影像学特征，包括MRI显示骨髓水肿和关节积液、X线显示新月征、临床表现为突然加重的髋关节疼痛。越来越多的证据表明这些征像是软骨下骨折的继发表现。值得一提的是，针对软骨下骨折的辨别，CT比MRI提供更多的信息，对围塌陷期的分期更为敏感。围塌陷期提示疾病进展可能性很大，同时提示此时进行保髋手术可以取得满意的中长期治疗效果。实际上，如果股骨头塌陷超过2mm，可以考虑关节置换。

围塌陷期具有明确的临床和影像特征，并为保髋手术治疗提供了较好的最后的机会。围塌陷期作为一个独特的分期，应该从股骨头坏死病程中区分出来，并为恰当的治疗措施提供依据。

图1. 股骨头坏死三柱理论与中日友好医院分型示意图。根据股骨头坏死受累部位，股骨头坏死可分为内侧型（M型）坏死累及内侧柱；中间型（C型）坏死累及中间柱；外侧型（L型）坏死累及外侧柱。L型又可分为：L1型外侧柱部分完好；L2型坏死范围超出外侧柱；L3型内中外三柱均受累及。ONFH:股骨头坏死。

表1. SARS病人股骨头坏死进展到围塌陷期自然病程；SARS: 严重急性呼吸窘迫综合征；ONFH:股骨头坏死。

原文摘要：

Pericollapse Stage of Osteonecrosis of the Femoral Head:A Last Chance for Joint Preservation

Objective:To propose a new definition of the pericollapse stage of osteonecrosis of the femoral head (ONFH) and review its significance in disease diagnosis and treatment selection.

Data sources:A search for eligible studies was conducted in three electronic databases including PubMed,Cochrane Library,and Embase up to August 10,2018,using the following keywords:"osteonecrosis","prognosis",and"treatment".

Study selection:Investigations appraising the clinical signs,symptoms, and imaging manifestations in different stages of ONFH were included.Articles evaluating the prognosis of various joint-preserving procedures were also reviewed.

Results:The pericollapse stage refers to a continuous period in the development of ONFH from the occurrence of subchondral fracture to early collapse (<2 mm),possessing specific imaging features that mainly consist of bone marrow edema and joint effusion on magnetic resonance imaging (MRI),crescent signs on X-ray films,and clinical manifestations such as the sudden worsening of hip pain.Accumulating evidence has indicated that these findings may be secondary to the changes after subchondral fractures.Of note,computed tomography provides more information for identifying possible subchondral fractures than does MRI and serves as the most sensitive tool for grading the pericollapse lesion stage.The pericollapse stage may indicate a high possibility of progressive disease but also demonstrates satisfactory long-and medium-term outcomes for joint-preserving techniques.In fact,if the articular surface subsides more than 2 mm,total hip arthroplasty is preferable.

Conclusions:The pericollapse stage with distinct clinical and imaging characteristics provides a last good opportunity for the use of joint-preserving techniques.It is necessary to separate the pericollapse stage as an independent state in evaluating the natural progression of ONFH and selecting an appropriate treatment regimen.

文献出处：Zhang QY,Li ZR,Gao FQ,Sun W.Pericollapse Stage of Osteonecrosis of the Femoral Head:A Last Chance for Joint Preservation.Chin Med J(Engl).2018 Nov 5;131(21):2589-2598.doi:10.4103/0366-6999.244111.PMID:30381593;PMCID:PMC6213842.