[骨坏死与类固醇相关性的临床研究]

[Clinical research of correlation between osteonecrosis and steroid].

作者信息

Li Zi-rong, Sun Wei, Qu Hui, Zhou Yi-xiong, Dou Bao-xin, Shi Zhen-cai, Zhang Nian-fei, Cheng Xiao-guang, Wang Da-li, Guo Wan-shou

机构信息

Center for Osteonecrosis & Joint-preserving Reconstruction, China-Japan Friendship Hospital, Beijing 100029, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2005 Aug 15;43(16):1048-53.

PMID:16194330

Abstract

OBJECTIVE

To explore the correlation between the dosage of corticosteroid, time of onset and incidence of osteonecrosis (ON) in patients with SARS.

METHODS

From July 2003 to January 2004, general survey carried out for ON in 551 patients with SARS. Five hundred and fifty-one patients except 12 were administrated by corticosteroid from 80 mg to 30 000 mg. The age of patients was (33 +/- 9) years old ranging from 19 to 59 years old. One hundred and thirty-one were male, and four hundred and twenty were female. MRI and X-ray film were taken in all patients including both hips, knees, shoulders, ankles and wrists. CT scan was taken in partial patients. Common classification system were used for staging of hip (ARCO), knee (Lotka) and shoulder (Cruess). Independent test, rank-sum test and multiple factor logistic regression analysis were used for statistical analysis.

RESULTS

No osteonecrosis was detected in 12 patients without corticosteroid. Osteonecrosis was detected in 176 patients (32.7 percent) among 539 patients. There were ON of femoral head in 130 cases (210 hips), ON of knee in 98 cases (130 knees), ON of humeral head in 21 cases (36 shoulders), ON of talus and calcaneus in 16 cases (26 ankles), ON of scaphoid and lunate in 11 cases (17 wrists), ON of patella in 3 cases (4 patella), ON of ilium in 1 case and bone infarction (femur, tibia) in 18 cases. One hundred and nineteen cases (195 hips) with ONFH were in stage I (IA 45 hips, IB 77 hips, IC 73 hips). Eleven cases (15 hips) were in stage II. All osteonecrosis of the knee and humoral head was stage I. Thirty-four patients with ON had one joint affected, 45 patients had 2 joints, 93 patients had more than 3 joints. The dosage of corticosteroid was (5842 +/- 4988) mg in ON group and (2719 +/- 2571) mg in non-ON group (P < 0.0001). The duration of steroid was (38 +/- 17) d in ON group and (27 +/- 15) d in non-ON group (P < 0.01). The dosage of pulse treatment was (340 +/- 207) mg/d in ON group and (211 +/- 160) mg/d in non-ON group (P < 0.01). The duration of pulse treatment was (28 +/- 13) d in ON group and (18 +/- 11) d in non-ON group (P < 0.01). All patients with ON were detected within 6 months from administration.

CONCLUSION

About one-third patients with SARS who were treated with a high dose of corticosteroid occurred osteonecrosis. ON is frequently multiple focuses. The actual time of onset of ON is early of steroid used. MRI is golden standard for early diagnosis of ON. The patients who were treated with a high dose of corticosteroid should be inspected initially by MRI.

摘要

目的

探讨严重急性呼吸综合征（SARS）患者糖皮质激素用量、发病时间与骨坏死发生率之间的相关性。

方法

2003年7月至2004年1月，对551例SARS患者进行骨坏死普查。551例患者中，除12例未使用糖皮质激素外，其余539例患者使用糖皮质激素剂量为80mg至30000mg。患者年龄为（33±9）岁，范围在19至59岁之间。男性131例，女性420例。所有患者均拍摄了包括双侧髋、膝、肩、踝及腕关节的MRI和X线片。部分患者进行了CT扫描。采用通用分类系统对髋关节（ARCO）、膝关节（Lotka）和肩关节（Cruess）进行分期。采用独立检验、秩和检验及多因素logistic回归分析进行统计学分析。

结果

12例未使用糖皮质激素的患者未检测到骨坏死。539例患者中，176例（32.7%）检测到骨坏死。其中股骨头坏死130例（210髋），膝关节坏死98例（130膝），肱骨头坏死21例（36肩），距骨和跟骨坏死16例（26踝），舟骨和月骨坏死11例（17腕），髌骨坏死3例（4髌），髂骨坏死1例，股骨和胫骨骨梗死18例。119例（195髋）股骨头坏死患者处于I期（IA期45髋，IB期77髋，IC期73髋）。11例（15髋）处于II期。所有膝关节和肱骨头坏死均为I期。34例骨坏死患者累及1个关节，45例累及2个关节，93例累及3个以上关节。骨坏死组糖皮质激素用量为（5842±4988）mg，非骨坏死组为（2719±2571）mg（P<0.0001）。激素使用时间骨坏死组为（38±1７）天，非骨坏死组为（27±15）天（P<0.01）。冲击治疗剂量骨坏死组为（340±207）mg/d，非骨坏死组为（211±160）mg/d（P<0.01）。冲击治疗时间骨坏死组为（28±13）天，非骨坏死组为（18±11）天（P<0.01）。所有骨坏死患者均在用药后6个月内被检测到。