He Wei, Zeng Qin, Zhang Qingwen, Li Yong, Pang Zhihui, Zeng Ping, Wang Haibin, Yuan Hao
Department of Orthopaedics, 1st Affiliated Hospital of Guangzhou Traditional Chinese Medicine University, Guangzhou Guangdong, 510405, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2008 Mar;22(3):299-302.
To explore the correlation between pain grading, stage of necrosis and bone marrow edema (BME) in nontraumatic osteonecrosis of femoral head (NONFH) so as to strengthen understandings about clinical significance of BME in NONFH.
From October 2004 to October 2006, 97 patients (149 hips) with NONFH were treated. There were 68 males and 29 femals with an average age of 38.8 years (19-62 years). The disease course was from 20 days to 4 years. BME was identified grade 0 to grade 2 according to MRI. Based on grading scale of pain, pain grading were divided into no pain (grade 0), mild pain (grade 1) and moderate or severe pain (grade 2). According to Association Research Circulation Osseous staging system, NONFH were divided into I-IV stages. The incidence rate of BME in each pain grading and stages of necrosis was analyzed respectively. Contingency table analyses and rank sum tests were used to compare the difference of pain grading and stages of necrosis among these groups.
The total incidence rate of BME was 73.15% (109/149), the incidence rates were 84.38% in pain groups (108/128) and 94.12% in the grade 2 (32/34). Pain grading correlated with BME rating (P < 0.001). The results of rank sum tests for several independent samples showed significant difference in BME among pain groups(P < 0.001). With the advance of pain scale, the mean rank of BME increased gradually (28.19 for grade 0, 78.94 for grade 1 and 96.12 for grade 2). BME was more commonly and clearly seen in stage II (77.05%) and stage III (82.81%) of NONFH. Stage I-III of NONFH correlated with BME rating (P < 0.001). The results of rank sum tests showed significant difference in BME rating among three stages (P < 0.001). With the advance of disease, the rank of BME rating increased gradually (39.07 for grade 0, 60.16 for grade 1 and 86.15 for grade 2).
BME is a sign that is accompanied with NONFH. The probability and extent of BME correlated well with the pain and stage of NONFH. The condition of BME can be used as a index for the appraisal of advancement of disease and the judgment of treatment result.
探讨非创伤性股骨头坏死（NONFH）患者疼痛分级、坏死分期与骨髓水肿（BME）之间的相关性，以加深对BME在NONFH中临床意义的认识。
选取2004年10月至2006年10月收治的97例（149髋）NONFH患者，其中男68例，女29例，平均年龄38.8岁（19 - 62岁），病程20天至4年。根据MRI将BME分为0 - 2级。依据疼痛分级标准，将疼痛分为无痛（0级）、轻度疼痛（1级）和中度或重度疼痛（2级）。按照骨循环研究协会分期系统，将NONFH分为I - IV期。分别分析各疼痛分级及坏死分期中BME的发生率。采用列联表分析和秩和检验比较各组间疼痛分级及坏死分期的差异。
BME总发生率为73.15%（109/149），疼痛组发生率为84.38%（108/128），2级疼痛组发生率为94.12%（32/34）。疼痛分级与BME分级相关（P < 0.001）。多个独立样本的秩和检验结果显示，疼痛组间BME差异有统计学意义（P < 0.001）。随着疼痛程度加重，BME平均秩次逐渐升高（0级为28.19，1级为78.94，2级为96.12）。BME在NONFH的II期（77.05%）和III期（82.81%）更为常见且明显。NONFH的I - III期与BME分级相关（P < 0.001）。秩和检验结果显示，三期之间BME分级差异有统计学意义（P < 0.001）。随着病情进展，BME分级秩次逐渐升高（0级为39.07，1级为60.16，2级为86.15）。
BME是NONFH伴随出现的征象，其发生概率及程度与NONFH的疼痛程度和分期密切相关。BME情况可作为评估病情进展及判断治疗效果的指标。
