Sen Ramesh Kumar, Tripathy Sujit Kumar, Gill Shivinder Singh, Verma Neelam, Singh Paramjeet, Radotra Bishan Dass
Department of Orthopaedics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Acta Orthop Belg. 2010 Aug;76(4):486-92.
Twenty-two patients with unreduced hip dislocation or fracture dislocation were prospectively evaluated. Intraosseous aspiration, marrow fluid analysis and core biopsy histological analysis was performed from the supero-lateral (test group) and central part (control group) of the femoral head. After appropriate surgical treatment and postoperative management, they were followed up for 2 years by clinical, radiological and magnetic resonance imaging evaluation. Eight patients eventually developed avascular necrosis (AVN) of the femoral head. The analysis of test samples revealed that 9 patients had an aspirate volume of < 1 cc ; marrow morphology of 11 hips showed necrotic cells; 12 patients had a core biopsy histology suggestive of dead osseous fragments and necrotic osteocytes. In contrast, all the control samples had an aspirate volume of > 1cc and showed viable cells on histology. Intra-operative assessment of marrow-aspirate volume (< 1cc), marrow morphology and core biopsy histology from the superolateral part of femur head can fairly predict the development of subsequent ONFH after trauma; the correlation is statistically significant (p < 0.05).
对22例未复位的髋关节脱位或骨折脱位患者进行了前瞻性评估。从股骨头的上外侧（试验组）和中央部分（对照组）进行骨髓穿刺、骨髓液分析和核心活检组织学分析。经过适当的手术治疗和术后管理，通过临床、放射学和磁共振成像评估对他们进行了2年的随访。8例患者最终发生了股骨头缺血性坏死（AVN）。试验样本分析显示，9例患者的穿刺抽液量<1cc；11个髋关节的骨髓形态显示有坏死细胞；12例患者的核心活检组织学提示有死骨碎片和坏死骨细胞。相比之下，所有对照样本的穿刺抽液量>1cc，且组织学显示为活细胞。术中对股骨头外侧部分的骨髓穿刺抽液量（<1cc）、骨髓形态和核心活检组织学进行评估，可以较为准确地预测创伤后随后发生的股骨头缺血性坏死的发展；相关性具有统计学意义（p<0.05）。
