人工骨修复材料在股骨头坏死修复中的应用

doi:10.3877/cma.j.issn.1674-134X.2026.01.010

股骨头坏死（ONFH）是一种由多因素诱发的股骨头血供障碍及骨细胞坏死的进行性病理改变，目前临床上尚缺乏根治性治疗手段。随着病程的发展，骨细胞凋亡和骨小梁微结构破坏会导致股骨头生物力学性能显著下降，最终引发软骨下骨结构塌陷和关节软骨面完整性丧失。因此，对于ONFH早中期治疗的关键是"保髋"策略，以延缓病情和防止股骨头塌陷。髓芯减压术（CD）作为当前"保髋"治疗的核心术式，虽能有效清除坏死硬化骨组织，但可能破坏软骨下骨力学支撑结构，存在加速股骨头塌陷的潜在风险。因此，临床实践中常联合应用骨移植或人工骨修复材料植入技术，通过构建稳定的立体支撑体系，维持生物力学完整性并促进骨组织再生修复。人工骨修复材料因良好的生物性能和来源广泛，被广泛应用于ONFH治疗。随着ONFH病理生理机制和人工骨修复材料研究的深入，新型材料研发已从传统的生物相容性和骨传导性要求，拓展至骨免疫调控性能与力学支撑性能的协同优化，以期实现骨再生微环境调控与力学支撑的精准平衡。本文系统综述近年来国内外ONFH治疗相关的人工骨修复材料的研究进展，旨在为人工骨修复材料的优化选择及临床应用提供科学依据。

关键词: 股骨头坏死, 骨替代物, 生物相容性材料, 骨再生, 成骨作用

Osteonecrosis of the femoral head (ONFH) represents a debilitating progressive disorder driven by multifactorial etiologies that impair osseous vascularization and trigger osteocyte death, with no definitive therapeutic intervention currently established. Pathological progression involves apoptotic cascades within osteocytic networks and trabecular microarchitectural deterioration, culminating in catastrophic biomechanical failure of the femoral head through subchondral collapse and articular cartilage disintegration. Contemporary management prioritizes early-stage joint preservation strategies to decelerate disease advancement and avert structural collapse. Core decompression (CD), while serving as the cornerstone surgical modality for necrotic debridement, paradoxically destabilizes subchondral mechanical integrity, thereby potentiating collapse acceleration. To mitigate this iatrogenic risk, CD is increasingly augmented with osteoconductive grafts or synthetic bone substitutes to simultaneously reconstitute load-bearing frameworks and stimulate endogenous osteogenesis. Modern synthetic bone scaffolds have gained prominence in ONFH therapy due to their exceptional biocompatibility, osteogenic potential, and scalable manufacturing. Recent paradigm shifts in material design transcend conventional paradigms of biocompatibility and passive osteoconduction, instead prioritizing convergent engineering approaches that synchronize osteoimmunomodulatory precision with biomechanical resilience. This strategic integration aims to orchestrate a harmonious equilibrium between immunometabolic bone niche modulation and structural reinforcement. The present review critically evaluated state of the art innovations in bioengineered bone substitutes for ONFH, offering evidence-based perspectives to refine clinical translation and material optimization.

Key words: Femur head necrosis, Bone substitutes, Biocompatible materials, Bone regeneration, Osteogenesis

表1 生物材料横向对比总结

Table 1 Comparative Summary of Biomaterial Properties

材料类型	力学性能	生物相容性	核心优势	技术瓶颈	典型应用
生物陶瓷	高硬度、高抗压强度，但脆性大	优异	生物相容性、骨传导性	脆性高、加工难	骨缺损填充、涂层材料
生物活性玻璃	中等强度，脆性较高	优异，表面可促进骨结合	骨传导/骨诱导双功能	力学性能差、成分敏感	骨缺损修复、涂层材料
医用金属	高强度、高韧性，耐疲劳	良好，但金属离子可能释放	高强度、耐疲劳	降解控制难、生物活性不足	关节假体、骨组织工程支架
高分子聚合物	弹性好，韧性高，但强度较低	良好，部分材料可能引发炎症	可降解、易加工	强度低、降解炎症风险	可吸收骨钉、骨组织工程支架
纳米材料	力学性能可调，可增强复合材料	优异，表面效应增强生物活性	高比表面积、多功能	安全性存疑、分散不均	药物载体、复合增强相

表1 生物材料横向对比总结

Table 1 Comparative Summary of Biomaterial Properties

材料类型	力学性能	生物相容性	核心优势	技术瓶颈	典型应用
生物陶瓷	高硬度、高抗压强度，但脆性大	优异	生物相容性、骨传导性	脆性高、加工难	骨缺损填充、涂层材料
生物活性玻璃	中等强度，脆性较高	优异，表面可促进骨结合	骨传导/骨诱导双功能	力学性能差、成分敏感	骨缺损修复、涂层材料
医用金属	高强度、高韧性，耐疲劳	良好，但金属离子可能释放	高强度、耐疲劳	降解控制难、生物活性不足	关节假体、骨组织工程支架
高分子聚合物	弹性好，韧性高，但强度较低	良好，部分材料可能引发炎症	可降解、易加工	强度低、降解炎症风险	可吸收骨钉、骨组织工程支架
纳米材料	力学性能可调，可增强复合材料	优异，表面效应增强生物活性	高比表面积、多功能	安全性存疑、分散不均	药物载体、复合增强相

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Application of artificial bone repair materials in osteonecrosis of femoral head

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Application of artificial bone repair materials in osteonecrosis of femoral head