Objective: To summarize the research progress on the role of macrophage-mediated osteoimmune in osteonecrosis of the femoral head (ONFH) and its mechanisms.
Methods: Recent studies on the role and mechanism of macrophage-mediated osteoimmune in ONFH at home and abroad were extensively reviewed. The classification and function of macrophages were summarized, the osteoimmune regulation of macrophages on chronic inflammation in ONFH was summarized, and the pathophysiological mechanism of osteonecrosis was expounded from the perspective of osteoimmune, which provided new ideas for the treatment of ONFH.
Results: Macrophages are important immune cells involved in inflammatory response, which can differentiate into classically activated type (M1) and alternatively activated type (M2), and play specific functions to participate in and regulate the physiological and pathological processes of the body. Studies have shown that bone immune imbalance mediated by macrophages can cause local chronic inflammation and lead to the occurrence and development of ONFH. Therefore, regulating macrophage polarization is a potential ONFH treatment strategy. In chronic inflammatory microenvironment, inhibiting macrophage polarization to M1 can promote local inflammatory dissipation and effectively delay the progression of ONFH; regulating macrophage polarization to M2 can build a local osteoimmune microenvironment conducive to bone repair, which is helpful to necrotic tissue regeneration and repair to a certain extent.
Conclusion: At present, it has been confirmed that macrophage-mediated chronic inflammatory immune microenvironment is an important mechanism for the occurrence and development of ONFH. It is necessary to study the subtypes of immune cells in ONFH, the interaction between immune cells and macrophages, and the interaction between various immune cells and macrophages, which is beneficial to the development of potential therapeutic methods for ONFH.
目的: 总结巨噬细胞介导的骨免疫在股骨头坏死（osteonecrosis of the femoral head，ONFH）中的作用及其机制研究进展。.
方法: 广泛查阅近年国内外有关巨噬细胞介导的骨免疫在ONFH中的作用及其机制的研究，归纳巨噬细胞分类和功能，总结其对ONFH中慢性炎症的骨免疫调控作用，从骨免疫学层面阐述骨坏死病理生理机制，为ONFH治疗提供新思路。.
结果: 巨噬细胞是参与炎症反应的重要免疫细胞，可分化为经典活化型（M1型）和选择活化型（M2型），发挥特定功能参与并调节机体的生理病理过程。研究表明，巨噬细胞介导的骨免疫失衡会引起局部慢性炎症并导致ONFH进展。因此，调控巨噬细胞极化是潜在的ONFH治疗策略，包括在慢性炎症免疫微环境中，抑制巨噬细胞向M1型极化可促进局部炎症消退，有效延缓ONFH进展；调控巨噬细胞向M2型极化，构建局部利于骨修复的骨免疫微环境，在一定程度上利于坏死组织再生修复。.
结论: 目前研究已明确巨噬细胞介导慢性炎症免疫微环境是ONFH进展的重要机制，后续需要对ONFH中各种免疫细胞的亚型、各种免疫细胞之间以及各种免疫细胞与巨噬细胞之间的相互作用进行研究，有利于开发ONFH潜在治疗手段。.
Keywords: Osteonecrosis of the femoral head; chronic inflammation; macrophage; osteoimmunology.