目的

探索股骨头坏死髓芯减压手术的整体知识结构、全球研究现状及发展趋势；结合本中心病例，验证该手术技术临床疗效及价值。

方法

通过Web of Science 核心合集数据库检索股骨头坏死髓芯减压术相关文献，时间跨度为建库至2024 年1 月1 日，利用VOSviewer 软件、Scimago 软件对股骨头坏死髓芯减压技术领域的合著情况、研究成果的地域分布、热点主题和研究热点的时区分布进行数据分析，并生成可视化知识图谱。综合评估股骨头坏死保髋治疗的现状和发展趋势。回顾分析我院于2017 年10 月至2023 年6 月期间，行单纯髓芯减压术或髓芯减压联合植骨术，治疗的ARCOⅠ-IIIA 期患者27 例，比较单侧髓芯减压联合植骨手术前、术后3 个月、术后末次随访时视觉模拟评分（visual analogue scale，VAS）、Harris 髋关节评分，根据手术前后X 线评估股骨头塌陷情况，评估再手术情况。

结果

本研究纳入论著及综述859 篇，其中中国学者的总发文量最多，其次是美国学者，然而美国学者Mont，Michael A.单人发文量最多（41 篇），美国学者Hungerford，ds.篇均被引次数最多（178.5 次/篇）；发文量前10 的科研机构中国机构数量最多，但西奈医院发文篇均被引101.13 次，更加被学界认可。关键词分析提示目前的研究重心不限于髓芯减压技术本身的研究，更加着眼于植骨材料的选择和细胞疗法的研究，髓芯减压联合植骨、细胞疗法是目前的热点。本研究共纳入27 例股骨头坏死患者作为研究对象，共32 个髋关节接受了髓芯减压手术治疗，其中14 个髋关节行单纯髓芯减压手术，18 个髋关节行髓芯减压联合植骨手术。14 个行单纯髓芯减压手术的髋关节中，7 个股骨头再次出现塌陷，股骨头塌陷率50%，6 个关节行全髋关节置换术，髋关节再手术率42.86%；18 个行髓芯减压植骨手术的髋关节中，5 个股骨头塌陷，股骨头塌陷率27.78%，3 个关节行全髋关节置换术，髋关节再手术率16.67%。9 个接受单侧髓芯减压联合植骨手术的患者术后获得良好的临床疗效，术后Harris 评分、VAS 评分均较术前得到明显改善（P＜0.01）。

结论

股骨头坏死髓芯减压术已受到学界重视，中国已成为该领域核心力量，具备一定的优势；植骨材料及再生细胞疗法是目前的研究热点，备受学界瞩目。髓芯减压联合植骨、细胞疗法是治疗早中期股骨头坏死的有效方案，可提高保髋率，推迟甚至避免患者行全髋关节置换手术。

Objective

To explore the overall knowledge structure， global research status， and development trends of core decompression for femoral head necrosis.Based on cases in our center， the clinical efficacy and value of this surgical technique were verified.

Methods

Relevant literatures on core decompression for osteonecrosis of the femoral head were searched through the Web of Science core collection database， with a time span from database establishment to January 1， 2024.VOSviewer and Scimago software were used to analyze the co authorship status， regional distribution of research results， hot topics， and time zone distribution of research hotspots in the field of core decompression technology in the treatment of osteonecrosis of the femoral head.And we generated a visual knowledge graph.The current status and development trends of hip preservation therapy for necrosis of the femoral head were comprehensively evaluated， and bibliometric results were correlated with the real-world data.A retrospective analysis was conducted on 27 patients with ARCO stage I-IIIA who underwent simple core decompression or core decompression combined with bone grafting in our hospital from October 2017 to June 2023.We compare the visual analog scale （VAS） and Harris hip joint score in patients undergoing unilateral core decompression combined with bone grafting before surgery， 3 months after surgery， and at the last follow-up after surgery.And we evaluate the collapse of the femoral head based on preoperative and postoperative X-ray， and evaluate the situation of reoperation.

Results

This study included 859 academic papers and reviews， with Chinese scholars having the highest total number of publications， followed by American scholars.However， American scholars Mont and Michael A.had the highest number of individual publications （41）， while American scholars Hungerford ds.had the highest number of citations （178.5 per article）.The top 10 research institutions in terms of publication volume have the highest number of Chinese institutions， but the articles published by Sinai Hospital have been cited 101.13 times， which is more recognized by the academic community.Keyword analysis suggests that the current research focus is not limited to the study of core decompression technology itself， but more on the selection of bone grafting materials and the study of cell therapy.Core decompression combined with bone grafting and cell therapy is currently a hot topic.A total of 27 patients with femoral head necrosis were included as the study subjects in this study， with a total of 32 hip joints undergoing core decompression surgery.Among them， 14 hip joints underwent simple core decompression surgery， and 18 hip joints underwent core decompression combined with bone grafting surgery.Among the 14 hip joints that underwent simple core decompression surgery， 7 femoral heads experienced another collapse with a 50%collapse rate， and 6 joints underwent total hip replacement with a 42.86% reoperation rate.Among the 18 hip joints undergoing core decompression and bone grafting surgery， 5 had femoral head collapse， with a collapse rate of 27.78%， and 3 joints underwent total hip replacement with a hip joint reoperation rate of 16.67%.9 patients who underwent unilateral core decompression combined with bone grafting surgery and did not undergo further surgery achieved good clinical efficacy after surgery.The Harris score and VAS score of those patients improved significantly after surgery （P＜0.01）.

Conclusion

Core decompression for necrosis of the femoral head has received attention from the academic community， and China has become a core force in this field with certain advantages.Bone grafting materials and regenerative cell therapy are current research hotspots that have attracted much attention from the academic community.Core decompression combined with bone grafting and cell therapy is an effective treatment for early and mid stage necrosis of the femoral head， which can improve hip preservation rate， delay or even avoid patients undergoing total hip replacement surgery.