Atsumi T, Kuroki Y
Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
Clin Orthop Relat Res. 1992 Apr(277):22-30.
To investigate the role of blood supply in the pathogenesis of idiopathic osteonecrosis of the femoral head, superselective angiography of the medial circumflex artery was performed. Sixteen hips with early stage osteonecrosis diagnosed by bone scintigraphy were studied, as were 22 contralateral normal hips (from unilateral cases) and 22 roentgenographically and scintigraphically normal hips in patients who had been administered corticosteroids. All hips demonstrated abnormal superior retinacular arteries in the extraosseous area, and small arteries penetrated 14 hips with early stage osteonecrosis. Abnormal findings were noted in 17 of 22 contralateral normal hips and in 20 of 22 normal hips with corticosteroid administration. Follow-up roentgenographic analysis showed that the hips with small arterial penetration most often developed osteonecrosis. There were two important findings: (1) The blood supply of the superior retinacular arteries from the extraosseous site was impaired. (2) Revascularization was observed not only in hips with early stage osteonecrosis but also in contralateral normal hips and normal hips with corticosteroid therapy. Osteonecrosis is not necessarily a consequence of a single episode of impairment of blood supply of the femoral head but that of a repetitive episode if interruption of revascularization.
为研究血供在股骨头缺血性坏死发病机制中的作用，对旋股内侧动脉进行了超选择性血管造影。研究对象包括16例经骨闪烁显像诊断为早期坏死的髋关节，22例对侧正常髋关节（来自单侧病例）以及22例接受过皮质类固醇治疗且X线和骨闪烁显像均正常的髋关节。所有髋关节在骨外区域均显示出异常的上支持带动脉，并且有小动脉穿入14例早期坏死的髋关节。在22例对侧正常髋关节中的17例以及22例接受皮质类固醇治疗的正常髋关节中的20例发现了异常表现。随访X线分析显示，有小动脉穿入的髋关节最常发生坏死。有两个重要发现：（1）来自骨外部位的上支持带动脉的血供受损。（2）不仅在早期坏死的髋关节中观察到了血管再生，在对侧正常髋关节以及接受皮质类固醇治疗的正常髋关节中也观察到了血管再生。股骨头缺血性坏死不一定是股骨头血供单次受损的结果，而是血管再生中断导致的反复受损的结果。
