切换至 "中华医学电子期刊资源库"

中华肩肘外科电子杂志 ›› 2023, Vol. 11 ›› Issue (01) : 89 -93. doi: 10.3877/cma.j.issn.2095-5790.2023.01.015

综述

肱骨头坏死的疾病特点及诊疗情况
汪磊1, 邢丹谋1,(), 王欢1   
  1. 1. 430000 华中科技大学同济医学院附属武汉普爱医院肩肘外科
  • 收稿日期:2022-09-24 出版日期:2023-02-05
  • 通信作者: 邢丹谋
  • 基金资助:
    武汉市医学科研项目(WX19Y19)

Disease characteristics and diagnosis and treatment of humeral head necrosis

Lie Wang1, Danmou Xing1(), Huan Wang1   

  • Received:2022-09-24 Published:2023-02-05
  • Corresponding author: Danmou Xing
引用本文:

汪磊, 邢丹谋, 王欢. 肱骨头坏死的疾病特点及诊疗情况[J]. 中华肩肘外科电子杂志, 2023, 11(01): 89-93.

Lie Wang, Danmou Xing, Huan Wang. Disease characteristics and diagnosis and treatment of humeral head necrosis[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2023, 11(01): 89-93.

肱骨头坏死是临床上常见的骨坏死之一。肱骨头的血供主要来源于旋肱前动脉和旋肱后动脉。由多因素导致的肱骨头血液供应受损,进而发生局部缺血时,肱骨头就会出现骨坏死。肱骨头坏死的病因可分为创伤性和非创伤性两大类,常见的创伤性因素有:骨折、脱位、肩部手术等;非创伤性因素有:糖皮质激素、血红蛋白病、沉箱病、戈谢病、吸烟、酗酒、系统性免疫病等。肱骨头坏死的主要症状是肩关节疼痛、活动受限。由于疾病早期通常无症状或症状较轻,不能引起患者重视,从而延误诊治。因此在临床工作中碰到高风险患者时,医务工作者要提高警惕,避免漏诊、误诊。肱骨头坏死可根据患者病史、临床表现、影像学检查来诊断。影像学检查是疾病分期的依据,疾病分期对治疗具有指导作用。早期肱骨头坏死可通过保守治疗取得较好效果,而晚期多需要手术治疗。无论采用何种治疗方法,其目的均是缓解疼痛、改善患肢功能。

表1 肱骨头坏死的Cruess分期
[20]
Schoch BS, Barlow JD, Schleck C, et al. Shoulder arthroplasty for atraumatic osteonecrosis of the humeral head [J]. J Shoulder Elbow Surg, 2016, 25(2): 238-245.
[21]
Schoch BS, Barlow JD, Schleck C, et al. Shoulder arthroplasty for post-traumatic osteonecrosis of the humeral head [J]. J Shoulder Elbow Surg, 2016, 25(3): 406-412.
[22]
Jobin CM, Galdi B, Anakwenze OA, et al. Reverse shoulder arthroplasty for the management of proximal humerus fractures [J]. J Am Acad Orthop Surg, 2015, 23(3): 190-201.
[23]
Hammond G, Tibone JE, McGarry MH, et al. Biomechanical comparison of anatomic humeral head resurfacing and hemiarthroplasty in functional glenohumeral positions [J]. J Bone Joint Surg Am, 2012, 94(1): 68-76.
[24]
Uribe JW, Botto-van Bemden A. Partial humeral head resurfacing for osteonecrosis [J]. J Shoulder Elbow Surg, 2009, 18(5): 711-716.
[25]
Hasegawa A, Mihata T, Shimizu H, et al. Osteochondral autograft transplantation for the treatment of steroid-induced osteonecrosis of the humeral head: a case report [J]. J Shoulder Elbow Surg, 2021, 30(2): E76-E83.
[26]
Inoue K, Suenaga N, Oizumi N, et al. A vascularized scapular graft for juvenile osteonecrosis of the humeral head [J]. J Shoulder Elbow Surg, 2012, 21(4): e9-e13.
[1]
Hernigou P, Hernigou J, Scarlat M. Shoulder Osteonecrosis: Pathogenesis, Causes, Clinical Evaluation, Imaging, and Classification [J]. Orthop Surg, 2020, 12(5): 1340-1349.
[2]
Duparc F, Muller JM, Fréger P. Arterial blood supply of the proximal humeral epiphysis [J]. Surg Radiol Anat, 2001, 23(3): 185-190.
[3]
Keough N, de Beer T, Uys A, et al. An anatomical investigation into the blood supply of the proximal humerus: surgical considerations for rotator cuff repair [J]. JSES Open Access, 2019, 3(4): 320-327.
[4]
Keough N, Lorke DE. The humeral head: A review of the blood supply and possible link to osteonecrosis following rotator cuff repair [J]. J Anat, 2021, 239(5): 973-982.
[5]
Hagiwara Y, Kanazawa K, Ando A, et al. Blood flow changes of the anterior humeral circumflex artery decrease with the scapula in internal rotation [J]. Knee Surg Sports Traumatol Arthrosc, 2015, 23(5): 1467-1472.
[6]
Hettrich CM, Boraiah S, Dyke JP, et al. Quantitative Assessment of the Vascularity of the Proximal Part of the Humerus [J]. J Bone Joint Surg, 2010, 92A(4): 943-948.
[7]
Ayyash AM, Bui TM, O'Brien MJ, et al. Management of Posttraumatic Avascular Necrosis of the Proximal Humerus [J]. Orthopedics, 2021, 44(6): 367-375.
[8]
Chang C, Greenspan A, Gershwin ME. The pathogenesis, diagnosis and clinical manifestations of steroid-induced osteonecrosis [J]. J Autoimmun, 2020, 110:102460.
[9]
Lancigu R, Rony L. Aseptic osteonecrosis of the shoulder: Etiologies, diagnosis and medical management [J]. Morphologie, 2021, 105(349): 148-154.
[10]
Sharareh B, Schwarzkopf R. Dysbaric osteonecrosis: a literature review of pathophysiology, clinical presentation, and management [J]. Clin J Sport Med, 2015, 25(2): 153-161.
[11]
中华医学会儿科学分会内分泌遗传代谢学组, 中华医学会儿科学分会血液学组, 中华医学会医学遗传学分会,等. 中国儿童戈谢病诊治专家共识(2021) [J]. 中华儿科杂志, 2021, 59(12): 1025-1031.
[12]
Hughes D, Mikosch P, Belmatoug N, et al. Gaucher Disease in Bone: From Pathophysiology to Practice [J]. J Bone Miner Res, 2019, 34(6): 996-1013.
[13]
Wang Y, Yin L, Li Y, et al. Preventive effects of puerarin on alcohol-induced osteonecrosis [J]. Clin Orthop Relat Res, 2008, 466(5): 1059-1067.
[14]
Wen Z, Lin Z, Yan W, et al. Influence of cigarette smoking on osteonecrosis of the femoral head (ONFH): a systematic review and meta-analysis [J]. Hip Int, 2017, 27(5): 425-435.
[15]
Alkhateeb JM, Arafah MA, Tashkandi M, et al. Surgical treatment of humeral head avascular necrosis in patients with sickle cell disease: a systematic review [J]. JSES Int, 2021, 5(3): 391-397.
[16]
Sweetnam DR, Mason RM, Murray RO. Steroid arthropathy of the hip [J]. Br Med J, 1960, 1(5183): 1392-1394.
[17]
Colegate-Stone TJ, Aggarwal S, Karuppaiah K, et al. The staged management of gleno-humeral joint osteonecrosis in patients with haematological-induced disease-a cohort review [J]. Int Orthop, 2018, 42(7): 1651-1659.
[18]
Kennon JC, Smith JP, Crosby LA. Core decompression and arthroplasty outcomes for atraumatic osteonecrosis of the humeral head [J]. J Shoulder Elbow Surg, 2016, 25(9): 1442-1448.
[19]
Harreld KL, Marker DR, Wiesler ER, et al. Osteonecrosis of the humeral head [J]. J Am Acad Orthop Surg, 2009, 17(6): 345-355.
[1] 吴克俭. 肱骨近端骨折髓内钉内固定[J]. 中华肩肘外科电子杂志, 2019, 07(01): 94-94.
阅读次数
全文


摘要