Popowski G, Gebhart M, Benkirane A, Petein M, Van Houtte P
Service de Chirurgie, Institut Jules Bordet, ULB, Bruxelles.
Acta Chir Belg. 1991 Sep-Oct;91(5):258-64.
Two cases of either cervical or acetabular osteoradionecrosis were described. One patient had endoprosthetic replacement of the hip, the other did not receive any surgical treatment. Regarding the literature, osteoradionecrosis occurs in 0.3 to 4% of the irradiated bones. Histologically there is a destruction of the bone by direct toxicity of the radiation and by destruction of the vascular supply. The threshold of irreversible bone destruction is 30 Gy. Fractures are epiphenomenons of osseous radionecrosis. The diagnosis can be suspected either by radiographies or by bone scans. Sometimes a bone biopsy is necessary to differentiate between bone necrosis, bone metastasis and eventually a radiation-induced sarcoma of the bone. If the osteoradionecrosis affects the acetabulum, even in the case of a stress fracture without acetabular protrusion of the femoral head, no surgical treatment is recommended. Weight bearing is avoided and spontaneous resolution occurs in most cases. If, on the other hand, there is a fracture through the femoral neck, hemiarthroplasty or total joint replacement is the treatment of choice. Total joint replacement is also recommended in case of an extensive radiation induced coxopathy.
本文描述了两例分别发生于颈椎或髋臼的放射性骨坏死病例。其中一例患者接受了髋关节假体置换，另一例未接受任何手术治疗。根据文献报道，放射性骨坏死在接受放疗的骨骼中发生率为0.3%至4%。组织学上，辐射的直接毒性作用以及血管供应破坏导致骨组织破坏。不可逆性骨破坏的阈值为30 Gy。骨折是骨放射性坏死的伴随现象。可通过X线摄影或骨扫描怀疑诊断。有时需要进行骨活检以区分骨坏死、骨转移以及最终的骨放射性肉瘤。如果放射性骨坏死累及髋臼，即使是在无股骨头髋臼突出的应力性骨折情况下，也不建议进行手术治疗。应避免负重，大多数情况下可自行缓解。另一方面，如果发生股骨颈骨折，半髋关节置换术或全关节置换术是首选治疗方法。对于广泛的放射性髋关节炎，也建议进行全关节置换。
