Huang Guo-Shu, Chan Wing P, Chang Yue-Cune, Chang Cheng-Yen, Chen Cheng-Yu, Yu Joseph S
Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, 325 Cheng-Kung Rd., Section 2, Neihu, Taipei 114, Taiwan, Republic of China.
AJR Am J Roentgenol. 2003 Aug;181(2):545-9. doi: 10.2214/ajr.181.2.1810545.
Our aim was to determine the occurrence of bone marrow edema and joint effusion and their relationship to pain in patients with osteonecrosis of the femoral head on the basis of MR imaging.
There were 71 patients with osteonecrosis of the femoral head based on characteristic radiographic and MR imaging findings. All patients had surgical confirmation of the disease. Both hips were affected with osteonecrosis in 39 patients, whereas only one hip was involved in 31 patients. The last patient underwent an arthroplasty of one hip during the study and had only one hip imaged. We evaluated a total of 110 hips in this study, of which 98 were painful. We staged osteonecrosis of the femoral head, using the classification of Steinberg et al. The 31 unaffected hips served as controls. Bone marrow edema and joint fluid were evaluated on MR images. Bone marrow edema was defined as an ill-defined area of low signal intensity on T1-weighted images with corresponding high signal intensity on T2-weighted or inversion recovery images localizing to the femoral head, neck, and intertrochanteric region. The amount of joint fluid was graded from 0 to 3.
The peak of bone marrow edema occurred in stage III disease (72%); its odds ratio was seven times greater than that for stage I osteonecrotic hips. Effusions of a grade greater than or equal to 2 were seen most often in stage III disease (92%), compared with 10% in the control hips. With an effusion, bone marrow edema was 12.6 times greater when the hip was painful than when it was not.
Both bone marrow edema and joint effusions existed with a peak occurrence in stage III disease. Bone marrow edema seems to have a stronger association with pain than does joint effusion in osteonecrosis of the femoral head.
我们的目的是基于磁共振成像（MR）确定股骨头坏死患者骨髓水肿和关节积液的发生率及其与疼痛的关系。
根据特征性的X线和MR成像表现，纳入71例股骨头坏死患者。所有患者均经手术确诊。39例患者双侧髋关节均发生坏死，31例患者仅一侧髋关节受累。最后1例患者在研究期间接受了一侧髋关节置换术，仅对一侧髋关节进行了成像。本研究共评估了110个髋关节，其中98个有疼痛症状。采用Steinberg等人的分类方法对股骨头坏死进行分期。31个未受累的髋关节作为对照。在MR图像上评估骨髓水肿和关节积液情况。骨髓水肿定义为T1加权图像上边界不清的低信号区，在T2加权或反转恢复图像上股骨头、股骨颈和转子间区域相应为高信号区。关节积液量从0到3级进行分级。
骨髓水肿的峰值出现在III期疾病（72%）；其优势比是I期坏死髋关节优势比的7倍。积液分级大于或等于2级在III期疾病中最为常见（92%），而对照髋关节中为10%。存在积液时，疼痛髋关节的骨髓水肿比无痛髋关节大12.6倍。
骨髓水肿和关节积液均存在，在III期疾病中发生率最高。在股骨头坏死中，骨髓水肿似乎比关节积液与疼痛的关联更强。
