Wenger D R, Birch J, Rathjen K, Tobin R, Billman G
Department of Orthopedic Surgery, Children's Hospital-San Diego, CA 92123.
J Pediatr Orthop. 1991 May-Jun;11(3):294-300.
We report the case histories, radiographic and computed tomographic studies, and histologic findings of two children with metachondromatosis who developed avascular necrosis (AVN) of the femoral ossific nucleus. The first was a 9-year-old boy with involvement of both femoral heads; the second was an 8-year-old girl with involvement of her right femoral head. The changes were associated with either exostoses or enchondromalike lesions of the femoral neck. Interference with the integrity of the lateral epiphyseal vessels by these lesions would explain the avascular changes that occurred. The findings in these cases and other reports associating AVN with skeletal dysplasia should encourage treating physicians to analyze carefully a sudden increase in hip pain or rapid radiographic development of femoral head collapse in a child with a skeletal dysplasia. Recognition of true AVN, in contrast to the gradual evolution of head shape change in typical skeletal dysplasia, may change treatment recommendations and prognosis.
我们报告了两例患有软骨瘤病的儿童发生股骨骨化核缺血性坏死（AVN）的病例史、X线和计算机断层扫描研究以及组织学 findings。第一例是一名9岁男孩，双侧股骨头均受累；第二例是一名8岁女孩，右侧股骨头受累。这些变化与股骨颈的外生骨疣或软骨瘤样病变有关。这些病变对外侧骨骺血管完整性的干扰可以解释所发生的缺血性变化。这些病例的 findings 以及其他将AVN与骨骼发育异常相关联的报告，应促使治疗医生仔细分析患有骨骼发育异常的儿童突然出现的髋部疼痛增加或股骨头塌陷的快速影像学进展情况。与典型骨骼发育异常中头部形状的逐渐演变相比，识别真正的AVN可能会改变治疗建议和预后。
