Prevention and early treatments of steroid-induced osteonecrosis of the femoral head / 中华骨科杂志

ABSTRACT

With the heavily application of steroid in the clinic, the incidence of steroid-induced osteonecrosis of the femoral head is also rapidly increasing. It is generally believed that steroid-induced osteonecrosis of the femoral head is the result of a various of pathological mechanisms. Clinical evidence suggests that the occurrence of osteonecrosis is highly correlated with the daily mean dose and cumulative dose of steroid. Patients don't always have osteonecrosis of the femoral head which may be related to the susceptibility of individual genes to steroid. Steroid-induced osteonecrosis of the femoral head is divided into three stages by pathomorphological, indicating the early, middle and late stage of blood supply changes. With the change of blood supply, the range of osteonecrosis is gradually increasing, and eventually leads to collapses. The earlier the osteonecrosis is found, the more selective the treatments regimen are. The prognosis will be often better with early diagnosis. Regulating the use of steroid can reduce the occurrence of osteonecrosis. Thus, we emphasize that the use of steroid in clinical settings should be cautious and regulated. Digital subtraction angiography can be used to assess early osteonecrosis of the femoral head. According to the assessment of progression of disease, the drug or the corresponding surgical procedure will be selected. Steroid-induced osteonecrosis of the femoral head can achieve good clinical results through early detection and early treatments.