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镰状细胞病成年患者股骨头无症状性骨坏死的自然病史。

The natural history of asymptomatic osteonecrosis of the femoral head in adults with sickle cell disease.

作者信息

Hernigou Ph, Habibi A, Bachir D, Galacteros F

机构信息

Service de Chirurgie Orthopédique, Hôpital Henri Mondor, 94010 Creteil, France.

出版信息

J Bone Joint Surg Am. 2006 Dec;88(12):2565-72. doi: 10.2106/JBJS.E.01455.

Abstract

BACKGROUND

Osteonecrosis of the femoral head is a frequent complication in adult patients with sickle cell disease. However, little is known about the natural history of asymptomatic lesions.

METHODS

One hundred and twenty-one patients (121 hips) with sickle cell disease and asymptomatic osteonecrosis of the femoral head that was contralateral to a hip with symptomatic osteonecrosis were identified with magnetic resonance imaging between 1985 and 1995. The lesions were graded with use of the Steinberg classification system. The patients were followed with annual plain radiographs. The mean duration of follow-up was fourteen years.

RESULTS

At the time of the initial evaluation, fifty-six hips were classified as Steinberg stage 0, forty-two hips were classified as Steinberg stage I, and twenty-three hips were classified as Steinberg stage II. At the time of the most recent follow-up, pain had developed in 110 previously asymptomatic hips (91%) and collapse had occurred in ninety-three hips (77%). Symptoms always preceded collapse. Of the fifty-six hips that were classified as Steinberg stage 0 at the time of the initial evaluation, forty-seven (84%) had symptomatic osteonecrosis and thirty-four (61%) had collapse at the time of the most recent follow-up. Of the forty-two asymptomatic stage-I hips, forty (95%) became symptomatic within three years and thirty-six (86%) had collapse of the femoral head. Of the twenty-three asymptomatic stage-II hips, all became symptomatic within two years and all collapsed; the mean interval between the onset of pain and collapse was eleven months. At the time of the final follow-up, ninety-one hips (75%) had intractable pain and required surgery.

CONCLUSIONS

Untreated asymptomatic osteonecrosis of the femoral head in patients with sickle cell disease has a high likelihood of progression to pain and collapse. Because of the high prevalence of complications after total hip arthroplasty in patients with this disease, consideration should be given to early surgical intervention with other procedures in an attempt to retard progression of the disease.

摘要

背景

股骨头坏死是成年镰状细胞病患者常见的并发症。然而,对于无症状病变的自然病程知之甚少。

方法

1985年至1995年间,通过磁共振成像确定了121例(121髋)患有镰状细胞病且股骨头无症状性坏死的患者,其坏死位于有症状性坏死髋的对侧。采用斯坦伯格分类系统对病变进行分级。每年对患者进行X线平片随访。平均随访时间为14年。

结果

初始评估时,56髋被分类为斯坦伯格0期,42髋被分类为斯坦伯格I期,23髋被分类为斯坦伯格II期。在最近一次随访时,110例先前无症状的髋部出现了疼痛(91%),93髋发生了塌陷(77%)。症状总是先于塌陷出现。初始评估时被分类为斯坦伯格0期的56髋中,47髋(84%)在最近一次随访时出现了有症状的坏死,34髋(61%)发生了塌陷。42例无症状的I期髋中,40例(95%)在3年内出现症状,36例(86%)发生股骨头塌陷。23例无症状的II期髋中,均在2年内出现症状并全部塌陷;疼痛发作至塌陷的平均间隔时间为11个月。在最后一次随访时,91髋(75%)出现顽固性疼痛并需要手术治疗。

结论

镰状细胞病患者未经治疗的无症状股骨头坏死极有可能进展为疼痛和塌陷。由于该病患者全髋关节置换术后并发症发生率较高,应考虑采用其他手术进行早期干预,以延缓疾病进展。

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