Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan.
Skeletal Radiol. 2010 Feb;39(2):189-92. doi: 10.1007/s00256-009-0834-3. Epub 2009 Dec 2.
A 57-year-old woman suffered rapid destruction of both hip joints over a 10 months period. At the first visit, her radiographs demonstrated slight joint space narrowing and acetabular cyst formation in both hips. Five months later, joint space narrowing had further progressed, and intra-articular injection of steroid was given in both hips. However, the hip pain gradually became worse. Five months later, both joint spaces had totally disappeared and both femoral heads had undergone massive collapse. At gross examination, both resected femoral heads showed extensive opaque yellow areas consistent with osteonecrosis. Microscopic examination of these areas revealed evidence of both extensive fracture and callus formation, as well as necrosis throughout, indicating that the osteonecrosis observed in this case was a secondary phenomenon superimposed on pre-existing osteoarthritis and subchondral fracture. There were many pseudogranulomatous lesions in the marrow space and necrotic area, where tiny fragments of bone and articular cartilage, surrounded by histiocytes and giant cells, were embedded, such as are typically seen in rapidly destructive arthrosis. No radiologic or morphologic evidence of primary osteonecrosis was noted. This case indicates that at least some cases of rapidly destructive arthritis are the result of subchondral fracture with superimposed secondary osteonecrosis.
一位 57 岁女性在 10 个月的时间内迅速累及双侧髋关节。初次就诊时，双侧髋关节 X 线片显示关节间隙轻度变窄，髋臼囊性变。5 个月后，关节间隙变窄进一步进展，双侧髋关节腔内注射类固醇。然而，髋关节疼痛逐渐加重。5 个月后，双侧关节间隙完全消失，双侧股骨头发生广泛塌陷。大体检查发现，切除的双侧股骨头均有广泛的不透明黄色区域，符合骨坏死的表现。这些区域的显微镜检查显示广泛骨折和骨痂形成的证据，以及整个坏死区域，表明本例观察到的骨坏死是继发于先前存在的骨关节炎和软骨下骨折的现象。骨髓腔和坏死区域有许多假肉芽瘤样病变，其中嵌入了小骨碎片和关节软骨，周围有组织细胞和巨细胞，这些病变在快速破坏性关节炎中很常见。没有发现原发性骨坏死的放射学或形态学证据。该病例表明，至少一些快速破坏性关节炎是由软骨下骨折合并继发骨坏死引起的。
