{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T13:47:57Z","timestamp":1772804877278,"version":"3.50.1"},"reference-count":60,"publisher":"Georg Thieme Verlag KG","issue":"03","license":[{"start":{"date-parts":[[2022,6,30]],"date-time":"2022-06-30T00:00:00Z","timestamp":1656547200000},"content-version":"vor","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev Bras Ortop (Sao Paulo)"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Resumo<\/jats:title><jats:p>Entre as patologias que acometem a articula\u00e7\u00e3o coxofemoral, a osteonecrose da cabe\u00e7a femoral (ONCF) \u00e9 provavelmente a mais intrigante e desafiadora. Consiste em uma doen\u00e7a multifatorial, com um espectro muito vari\u00e1vel em sua apresenta\u00e7\u00e3o cl\u00ednica. Tem efeito devastador, devido a quadros dolorosos incapacitantes tanto para atividades habituais quanto esportivas. Dada a gama enorme de fatores de risco, tais como uso prolongado de corticoides (principalmente em casos de doen\u00e7as reumatol\u00f3gicas), sequelas de trauma, anemia falciforme, HIV, etilismo, tabagismo, discrasias sangu\u00edneas, e v\u00e1rias outras doen\u00e7as que comprometem a irriga\u00e7\u00e3o sangu\u00ednea da cabe\u00e7a femoral, a ONCF tem apresenta\u00e7\u00e3o cl\u00ednica e progn\u00f3sticos bem variados, o que dificulta a determina\u00e7\u00e3o de um tratamento espec\u00edfico, especialmente em casos nos quais ainda n\u00e3o houve acometimento condral e a articula\u00e7\u00e3o do quadril ainda se mant\u00e9m preservada, sendo estes os principais fatores encontrados na literatura que determinam as classifica\u00e7\u00f5es desta patologia. No leque de tratamentos, encontramos diversas op\u00e7\u00f5es para os casos em que se tenta salvar a articula\u00e7\u00e3o: tratamento conservador, descompress\u00e3o simples e\/ou associada a algum tipo de tratamento adjuvante (enxertia hom\u00f3loga, enxertia sint\u00e9tica, enxertos vascularizados, parafusos de t\u00e2ntalo, e inje\u00e7\u00e3o de aspirado de medula \u00f3ssea), e, para casos nos quais j\u00e1 h\u00e1 fratura subcondral e\/ou colapso da cabe\u00e7a femoral e\/ou diminui\u00e7\u00e3o do espa\u00e7o articular, reserva-se, comumente, a realiza\u00e7\u00e3o de osteotomias femorais ou artroplastia total do quadril.<\/jats:p>","DOI":"10.1055\/s-0041-1736308","type":"journal-article","created":{"date-parts":[[2022,6,30]],"date-time":"2022-06-30T22:53:47Z","timestamp":1656629627000},"page":"351-359","source":"Crossref","is-referenced-by-count":5,"title":["Osteonecrose da cabe\u00e7a femoral: Artigo de 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Fukushima","year":"2014"},{"issue":"12","key":"ref2","doi-asserted-by":"crossref","first-page":"2165","DOI":"10.2106\/JBJS.I.00575","article-title":"The natural history of untreated osteonecrosis of the femoral head","volume":"92","author":"M Mont","year":"2010","journal-title":"J Bone Joint Surg Am"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s12178-015-9277-8","article-title":"Pathophysiology and risk factors for osteonecrosis","volume":"8","author":"K N Shah","year":"2015","journal-title":"Curr Rev Musculoskelet Med"},{"key":"ref4","first-page":"601763","article-title":"The pathogenesis of nontraumatic osteonecrosis","volume":"2012","author":"J Seamon","year":"2012","journal-title":"Arthritis (Egypt)"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1186\/s12891-019-2990-5","article-title":"Risk factors associated with osteonecrosis of femoral head after internal fixation of femoral neck fracture:a 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