Bullough P G, DiCarlo E F
Department of Pathology, Cornell University Medical College, New York.
Ann Rheum Dis. 1990 Jun;49(6):412-20. doi: 10.1136/ard.49.6.412.
(1) Subchondral avascular necrosis is an important cause of joint pain and disability and accounts for upwards of 20% of total hip replacements done in our hospital. (2) Early diagnosis may be made with the aid of magnetic resonance imaging and radioactive isotope studies. (3) Although the signs and symptoms are similar to those of osteoarthritis, there are significant differences--namely, (a) a history of sudden onset of pain, present in more than half the patients; (b) a younger age group; (c) a shorter duration of symptoms at time of surgery; (d) clinically the limiting factor is pain rather than actual joint deformity to account for restriction of movement; (e) a high incidence of multiple sites of involvement. (4) The disease is commonly associated with steroid treatment or alcohol abuse. Although many other causes are recognised, they are rare in Western urban practice. (5) Patients with stage I-II subchondral avascular necrosis, especially of the knee, are better treated conservatively. (6) Surgical treatment gives less satisfactory results than the treatment of osteoarthritis by similar modalities.
(1) 软骨下骨缺血性坏死是关节疼痛和残疾的重要原因，在我院进行的全髋关节置换手术中占比超过20%。(2) 借助磁共振成像和放射性同位素研究可进行早期诊断。(3) 尽管其体征和症状与骨关节炎相似，但存在显著差异——即：(a) 半数以上患者有突发疼痛史；(b) 发病年龄较轻；(c) 手术时症状持续时间较短；(d) 临床上限制活动的因素是疼痛而非实际关节畸形；(e) 多部位受累的发生率较高。(4) 该疾病通常与类固醇治疗或酗酒有关。尽管还认识到许多其他病因，但在西方城市的临床实践中较为罕见。(5) I-II期软骨下骨缺血性坏死患者，尤其是膝关节患者，采用保守治疗效果更佳。(6) 与采用类似方式治疗骨关节炎相比，手术治疗的效果较差。
