Lequesne M, Bensasson M, Kahn M F, de Sèze S
Rev Rhum Mal Osteoartic. 1975 Mar;42(3):177-83.
The authors report on 14 cases of osteonecrosis of the femoral head (ONFH) in patients suffering from gout. The cases of association were discovered over a period of 10 years among 232 patients with ONFH and 651 with gout. The necrosis had no particular characteristics except that there was a clear preponderence in males and a slight tendency to be bilateral; it occurred, perhaps, at a slightly earlier age. The patients with gout did not show any special clinical features ; the gout always preceded the necrosis, on average by 7 1/2 years. There was no obvious history of painful crises in the hip that could be attributed to the acute gout, except in one case. The excess of urate was detected by the baseline level of uricaemia (91 mg/litre on average), by the frequency of tophus (4 out of 14), and by the frequency of urinary lithiasis (2 out of 14), and did not appear to be any greater in the patients with gout and ONFH than it was in the whole of the population of gout patients. In those patients in whom it was estimated, the lipid analysis showed most frequently an increase in total lipids, in triglyceridaemia, and in cholesterolaemia. In the 5 patients in whom the investigations were sufficiently detailed, the dyslipidaemia was of Frederickson type II + IV (mixed hyperlipidaemia according to de Gennes' classification). Different physiopathological hypotheses are discussed by the authors, notably those concerned with micro-particulate fatty emboli (lipomicrons), which may obstruct, among others, the terminal arteries of the femoral head. Of the 6 patients for whom it was possible to obtain information, for an average period of 10 years since the onset of the necrosis, 2 had presented with untreated hyperlipidaemia and a severe general vascular illness (myocardial infarction in one case and regressive hemiplegia in the other). These findings lead to the conclusion that correction of the hyperlipidaemia by diet is indispensable to ensure the long-term survival of these patients.
作者报告了14例痛风患者的股骨头坏死（ONFH）病例。在10年期间，在232例股骨头坏死患者和651例痛风患者中发现了这些关联病例。除了男性明显占优势且有轻微双侧发病倾向外，坏死没有特殊特征；发病年龄可能稍早。痛风患者没有表现出任何特殊临床特征；痛风总是先于坏死出现，平均提前7.5年。除1例患者外，没有明显的髋部疼痛发作史可归因于急性痛风。通过血尿酸基线水平（平均91毫克/升）、痛风石出现频率（14例中有4例）和尿路结石出现频率（14例中有2例）检测到尿酸过多，痛风和股骨头坏死患者的尿酸过多情况似乎并不比整个痛风患者群体更严重。在那些进行了血脂分析的患者中，最常见的是总血脂、甘油三酯血症和胆固醇血症升高。在5例检查足够详细的患者中，血脂异常为弗雷德里克森II + IV型（根据德热内斯分类为混合性高脂血症）。作者讨论了不同的生理病理假说，特别是与微颗粒脂肪栓子（脂蛋白微粒）有关的假说，这些栓子可能会阻塞股骨头的终末动脉等。在6例能够获取信息的患者中，自坏死开始平均10年以来，2例患有未经治疗的高脂血症和严重的全身性血管疾病（1例为心肌梗死，另1例为退行性偏瘫）。这些发现得出结论，通过饮食纠正高脂血症对于确保这些患者的长期生存是必不可少的。
