Koo K H, Ahn I O, Kim R, Song H R, Jeong S T, Na J B, Kim Y S, Cho S H
Department of Orthopedic Surgery, Gyeong-Sang National University School of Medicine, Chinju, South Korea.
Radiology. 1999 Dec;213(3):715-22. doi: 10.1148/radiology.213.3.r99dc06715.
To determine whether the marrow edema around focal osteonecrosis on magnetic resonance (MR) images is associated with clinical symptoms.
Thirty-three patients with 37 hips showing early stage osteonecrosis of the femoral head were followed up at 3-month intervals with clinical evaluation, conventional radiography, and serial MR imaging.
Seven (50%) of 14 symptomatic hips showed marrow edema around focal osteonecrosis on initial MR images, whereas only one (4%) of 23 asymptomatic hips showed edema (P < .01). Six (86%) of seven hips that were moderately to severely painful were associated with surrounding marrow edema. All eight hips showing osteonecrosis with marrow edema at the initial MR examination had joint effusion and exhibited intense radionuclide uptake in the proximal femur, which corresponded to the extent of edema on MR images. In all eight hips, the marrow edema resolved on follow-up MR images, and the pain subsided with the resolution of edema.
The results of this study suggest that the combination of marrow edema of the proximal femur and focal osteonecrosis of the femoral head are strongly associated with hip pain in early stage osteonecrosis, even prior to collapse. Pain improvement usually parallels the resolution of edema.
确定磁共振（MR）图像上局灶性骨坏死周围的骨髓水肿是否与临床症状相关。
对33例共37髋股骨头早期骨坏死患者进行随访，每隔3个月进行临床评估、传统X线摄影及系列MR成像检查。
14例有症状的髋关节中，7例（50%）在初次MR图像上显示局灶性骨坏死周围有骨髓水肿，而23例无症状的髋关节中只有1例（4%）显示有水肿（P <.01）。7例中度至重度疼痛的髋关节中有6例（86%）与周围骨髓水肿有关。初次MR检查显示骨坏死伴有骨髓水肿的所有8髋均有关节积液，且股骨近端放射性核素摄取增强，这与MR图像上水肿范围相对应。在所有8髋中，随访MR图像上骨髓水肿消退，疼痛也随水肿消退而减轻。
本研究结果表明，股骨近端骨髓水肿与股骨头局灶性骨坏死同时存在，在早期骨坏死（甚至在塌陷之前）时与髋关节疼痛密切相关。疼痛改善通常与水肿消退同步。
