缺血性坏死 - 诊断与治疗 - 妙佑医疗国际

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缺血性坏死

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诊断

在体格检查过程中，医生可能会按压关节，检查是否有触痛。医生也可能以各种不同的姿势移动关节，以查看关节活动度是否变小。

影像学检查

许多疾病会引起关节疼痛。影像学检查可能有帮于确定疼痛的来源。可选方案包括： X 线检查。它们可以揭示在缺血性坏死晚期发生的骨骼变化。在这种病症的早期阶段，X 线通常不会发现异常。 MRI 和 CT 扫描。这些检查产生的详细图像会显示一些早期的骨骼变化，这些变化可能意味着缺血性坏死。骨扫描。将少量的放射性物质注入静脉。该示踪剂会移动到受伤或愈合的骨骼部位，并在成像板上显示为亮点。

Imaging tests

Many conditions can cause joint pain. Imaging tests can help pinpoint the source of pain. Tests may include: X-rays. They can reveal bone changes that occur in the later stages of avascular necrosis. In the condition's early stages, X-rays usually don't show any problems. MRI and CT scan. These tests produce detailed images that can show early changes in bone that might indicate avascular necrosis. Bone scan. A small amount of radioactive material is injected into a vein. This tracer travels to the parts of bones that are injured or healing. It shows up as bright spots on the imaging plate.

治疗

目的是预防进一步骨量丢失。

用药和治疗

在缺血性坏死早期，通过用药和治疗可以缓解症状。医生可能会建议：非甾体抗炎药。布洛芬（Advil、Motrin IB 等）、萘普生钠（Aleve）等药物可以缓解与缺血性坏死相关的疼痛。骨质疏松症药物。阿仑膦酸钠（Fosamax、Binosto）等药物可能延缓缺血性坏死的进展，但证据不一。降胆固醇药物。降低血液中的胆固醇和脂肪含量可能有助于防止可导致缺血性坏死的血管阻塞。血液稀释剂。如果您有凝血障碍，可能会建议您使用华法林（Coumadin、Jantoven）之类的血液稀释剂，以防止为骨骼供血的血管中出现血凝块。休息。减轻体重和受累骨骼所承受的应力可以减缓损伤。您可能需要在几个月内限制身体活动或使用拐杖来避免关节承重。运动。物理治疗师可以教您如何锻炼，以保持或改进关节活动度。电刺激。电流可促进您的身体长出新骨骼来代替受损骨骼。电刺激可在外科手术中使用，并可直接应用于受损部位。也可通过连接至皮肤的电极施加电刺激。

外科手术及其他手术

因为大多数人直到缺血性坏死相当严重时才会出现症状，医生可能会建议您做外科手术。治疗方案包括：髓芯减压术。外科医生会切除骨骼的部分内层。除了减轻疼痛外，骨骼中的额外空间还能刺激健康骨组织和新血管的生长。骨移植（移植物）。此手术可以帮助加强受缺血性坏死影响的骨骼部位。移植物是从您身体的其他部位取出的一段健康骨骼。骨骼重塑（截骨术）。移除承重关节上方或下方的楔形骨块，以帮助将您的自身重量从受损骨骼上移开。骨骼重塑或许能使您推迟关节置换。关节置换。如果您的病骨已经塌陷或其他治疗方案无效，您可能需要通过外科手术用塑料或金属部件来置换关节的受损部分。再生医学治疗。骨髓抽吸和浓缩是一种较新的方法，可能适合早期髋关节缺血性坏死。从您的骨髓中提取干细胞。在外科手术过程中，将移除一小块坏死髋骨，然后将干细胞插入其位置，这可能会促使新骨生长。但还需要对此开展更多研究。

Medications

In the early stages of avascular necrosis, certain medications may help ease symptoms: Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter medications like ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) might help relieve pain associated with avascular necrosis. Stronger NSAIDs are available by prescription. Osteoporosis drugs. These types of medications might slow the progression of avascular necrosis, but the evidence is mixed. Cholesterol-lowering drugs. Reducing the amount of cholesterol and fat in the blood might help prevent the vessel blockages that can cause avascular necrosis. Medications that open blood vessels. Iloprost (Ventavis) might increase blood flow to the affected bone. More study is needed. Blood thinners. For clotting disorders, blood thinners, such as warfarin (Jantoven), might prevent clots in the vessels feeding the bones.

Therapy

Your health care provider might recommend: Rest. Restricting physical activity or using crutches for several months to keep weight off the joint might help slow the bone damage. Exercises. A physical therapist can teach exercises to help maintain or improve the range of motion in the joint. Electrical stimulation. Electrical currents might encourage the body to grow new bone to replace the damaged bone. Electrical stimulation can be used during surgery and applied directly to the damaged area. Or it can be administered through electrodes attached to the skin.

Surgical and other procedures

Because most people don't develop symptoms until avascular necrosis is advanced, your health care provider might recommend surgery. The options include: Core decompression. A surgeon removes part of the inner layer of bone. Besides reducing pain, the extra space inside the bone triggers the production of healthy bone tissue and new blood vessels. Bone transplant (graft). This procedure can help strengthen the area of bone affected by avascular necrosis. The graft is a section of healthy bone taken from another part of the body. Bone reshaping (osteotomy). A wedge of bone is removed above or below a weight-bearing joint, to help shift weight off the damaged bone. Bone reshaping might help postpone joint replacement. Joint replacement. If the affected bone has collapsed or other treatments aren't helping, surgery can replace the damaged parts of the joint with plastic or metal parts. Regenerative medicine treatment. Bone marrow aspirate and concentration is a newer procedure that might help avascular necrosis of the hip in early stages. During surgery, the surgeon removes a sample of dead hipbone and inserts stem cells taken from bone marrow in its place. This might allow new bone to grow. More study is needed.

临床试验

探索 Mayo Clinic 的研究测试新的治疗、干预与检查方法，旨在预防、检测、治疗或控制这种疾病。

准备您的预约

您的家庭医生可能会将您转诊给擅长关节疾病的医生（风湿病专家）或骨外科医生。

您能做些什么

请列出以下内容：您的症状，包括看似与本次约诊原因无关的症状，以及开始时间关键医疗信息，包括您的其他疾病以及疼痛关节的任何损伤史您服用的所有药物、维生素或其他补充剂及其剂量要问医生的问题如果可能，请让一位亲戚或朋友陪您，以便帮助您记住医生所提供的信息。关于缺血性坏死，要向医生咨询的一些问题包括：最可能是什么导致我的症状？我需要做哪些检查？有哪些治疗方法可供选择？我还有其他健康问题。我怎样才能同时管理好这些疾病？请随时提出其他问题。

医生可能做些什么

医生可能会问一些问题，包括：疼痛部位在哪？特定关节位置是否会使疼痛缓解或加重？您是否服用过泼尼松等类固醇？您的饮酒量是多少？

What you can do

Make a list of: Your symptoms, including those that seem unrelated to the reason you scheduled the appointment, and when they began Key medical information, including other conditions you have and history of injury to the painful joint All medications, vitamins or other supplements you take, including doses Questions to ask your provider Ask a relative or friend to accompany you, if possible, to help you remember the information you receive. Some questions to ask your provider about avascular necrosis include: What's the most likely cause of my symptoms? What tests do I need? What treatments are available? I have other health conditions. How can I best manage them together? Don't hesitate to ask other questions.

What to expect from your doctor

Your provider is likely to ask you questions, including: Where's your pain? Does a particular joint position make the pain better or worse? Have you ever taken steroids such as prednisone? How much alcohol do you drink? 来自妙佑医疗国际员工申请 Mayo Clinic 预约症状与病因医生与科室 July 02, 2022 打印 Share on: FacebookTwitterWeChat

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CloseWeibo 显示参考文献 Jones LC, et al. Osteonecrosis (avascular necrosis of bone). https://www.uptodate.com/contents/search. Accessed Feb. 23, 2018. AskMayoExpert. Avascular necrosis of the hip. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017. Patient fact sheet: Osteonecrosis. American College of Rheumatology. https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Osteonecrosis. Accessed Feb. 23, 2018. Osteonecrosis (ON). Merck Manual Professional Version. http://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/osteonecrosis/osteonecrosis-on. Accessed Feb. 23, 2018.