Yamamoto T, Bullough P G
Kyushu University, Japan.
Arthritis Rheum. 2000 Nov;43(11):2423-7. doi: 10.1002/1529-0131(200011)43:11<2423::AID-ANR8>3.0.CO;2-Z.
The pathophysiology of rapidly destructive arthrosis of the hip joint (RDA) is unknown. The purpose of this study was to document cases of subchondral insufficiency fracture of the femoral head, which has similar clinicoradiologic features to those of early-stage RDA.
This study was based on a retrospective review of 11 cases of subchondral insufficiency fracture of the femoral head that were confirmed histopathologically and for which radiographs both at the onset of hip pain and at the time of surgery were available.
All patients were > 60 years of age (range 61-78 years, mean age 69), and 9 were women. On plain radiographs, the normal joint space had undergone rapid narrowing and/or disappeared within 9 months (mean 5.8 months). Magnetic resonance imaging, available in 2 cases, showed a pattern of bone marrow edema from the upper portion of the femoral head to the intertrochanteric region, with an associated focal low-intensity band on T1 paralleling the articular surface. In all cases, evidence of subchondral insufficiency fracture was confirmed histopathologically. In addition, in the marrow space, there were several round-to-oval granulomatous foci, which consisted of amorphous debris, fragmented bone, and articular cartilage surrounded by reactive histiocytes and giant cells. All 11 patients were osteopenic, as shown both radiologically and histopathologically.
Subchondral insufficiency fracture resulting from osteopenia may lead to a rapid breakdown of the hip joint.
髋关节快速破坏性关节病（RDA）的病理生理学尚不清楚。本研究的目的是记录股骨头软骨下不全骨折的病例，其具有与早期RDA相似的临床放射学特征。
本研究基于对11例经组织病理学证实的股骨头软骨下不全骨折病例的回顾性分析，这些病例均有髋关节疼痛发作时及手术时的X线片。
所有患者年龄均>60岁（范围61 - 78岁，平均年龄69岁），其中9例为女性。在X线平片上，正常关节间隙在9个月内（平均5.8个月）迅速变窄和/或消失。2例患者的磁共振成像显示从股骨头上部到转子间区域有骨髓水肿模式，T1加权像上有一条与关节面平行的局灶性低强度带。所有病例经组织病理学证实存在软骨下不全骨折。此外，在骨髓腔内有几个圆形至椭圆形的肉芽肿病灶，由无定形碎片、碎骨和被反应性组织细胞及巨细胞包围的关节软骨组成。所有11例患者经放射学和组织病理学检查均显示为骨质减少。
骨质减少导致的软骨下不全骨折可能导致髋关节迅速破坏。
