Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
J Bone Joint Surg Am. 2010 Sep 15;92(12):2165-70. doi: 10.2106/JBJS.I.00575.
An asymptomatic hip with osteonecrosis is typically discovered as the contralateral hip of a patient with one symptomatic joint. Treatment of the asymptomatic hip is controversial. While some authors claim a benign natural history, others have reported a rate of femoral head collapse exceeding 50%. The purpose of this report was to systematically review the published literature regarding asymptomatic osteonecrosis of the femoral head to evaluate the overall prevalence of progression to symptomatic disease and/or femoral head collapse as well as to determine whether various radiographic and demographic factors influence progression of the disorder.
A comprehensive literature search was performed to identify prognostic studies evaluating asymptomatic hip osteonecrosis. Demographic, radiographic, and outcome data were extracted from all relevant studies. The prevalence of progression to symptomatic disease and/or femoral head collapse was determined. Next, outcomes were stratified by lesion size, lesion location, radiographic stage, associated risk factors and/or disease, and the level of evidence of the study.
Sixteen studies that included a total of 664 hips were available for an analysis of outcomes. Overall, 394 hips (59%) had progression to symptoms or collapse. Differences in outcomes based on lesion size, lesion location, and radiographic stage at the time of diagnosis were seen. Small, medially located lesions had the best prognosis, with a prevalence of collapse of <10%. Patients with sickle cell disease had the highest frequency of progression, and those with a history of systemic lupus erythematosus had the most benign course.
Data extracted from previously published studies suggest that asymptomatic osteonecrosis has a high prevalence of progression to symptomatic disease and femoral head collapse. While small, medially located lesions have a low rate of progression, the natural history of asymptomatic medium-sized, and especially large, osteonecrotic lesions is progression in a substantial number of patients. For this reason, it may be beneficial to consider joint-preserving surgical treatment in asymptomatic patients with a medium-sized or large, and/or laterally located, lesion.
患有一侧症状性髋关节骨坏死的患者，通常会偶然发现另一侧髋关节也有骨坏死。对于无症状性髋关节骨坏死的治疗存在争议。一些作者认为其具有良性的自然病程，而另一些作者则报道股骨头塌陷的发生率超过 50%。本报告旨在系统地回顾已发表的关于无症状性股骨头骨坏死的文献，以评估疾病进展为症状性疾病和/或股骨头塌陷的总体发生率，并确定各种影像学和人口统计学因素是否影响疾病的进展。
进行了全面的文献检索，以确定评估无症状性髋关节骨坏死的预后研究。从所有相关研究中提取人口统计学、影像学和结果数据。确定疾病进展为症状性疾病和/或股骨头塌陷的发生率。然后，根据病变大小、病变位置、影像学分期、相关危险因素和/或疾病以及研究的证据水平对结果进行分层。
共有 16 项研究，共纳入 664 髋，可用于分析结果。总体而言，有 394 髋（59%）进展为症状或塌陷。根据诊断时的病变大小、病变位置和影像学分期，结果存在差异。小的、内侧病变的预后最好，塌陷发生率<10%。镰状细胞病患者进展发生率最高，系统性红斑狼疮病史患者的病程最良性。
从先前发表的研究中提取的数据表明，无症状性骨坏死有很高的进展为症状性疾病和股骨头塌陷的发生率。虽然小的、内侧病变进展率较低，但无症状性中等大小、尤其是大的骨坏死病变的自然病程是相当一部分患者的病变进展。因此，对于中等大小或大的、且/或外侧病变的无症状患者，考虑关节保留手术治疗可能是有益的。
