Department of Orthopaedic Surgery, Affiliated Hospital of Xuzhou Medical College, Xuzhou, China.
Orthop Surg. 2012 Feb;4(1):28-34. doi: 10.1111/j.1757-7861.2011.00163.x.
To explore the clinical characteristics of osteonecrosis of the femoral head (ONFH) induced by steroids.
From January 2000 to October 2009, 497 hips in 270 cases of ONFH induced by steroids were studied. A questionnaire was administered when the patients were admitted; the questions concerned the underlying disease, duration of steroid usage, total dosage of steroid, incubation period (time interval between commencement of steroid therapy and onset of pain), severity of pain, location of initial complaint, primary diagnosis, time lag from onset of pain to final diagnosis and physical signs when admitted. The correlations between pain and Association Research Circulation Osseous (ARCO) stage, bone marrow edema (BME) and lesion size were analyzed.
The median of time between commencing steroid medication and developing ONFH for the 269 cases was 18 months (range, 2-384 months). 78.82% cases presented with pain within three years of steroid initiation, only 10.41% patients first complained of pain six or more years after commencing steroid therapy. Fifty-six cases (20.82%) were misdiagnosed, lumbar disorders being the most frequent misdiagnoses. 79.29% of symptomatic hips presented with abnormal physical tests. Of 420 symptomatic hips, 166 hips were type C1, 223 hips type C2; 299 hips had collapsed; and there was BME in 209 hips.
Most patients with ONFH induced by steroids complained of pain within 3 years of commencing steroid therapy. Pain was associated with lesion size, collapse and BME. Atypical location of pain, failure to perform a physical examination and MRI findings were the main causes of misdiagnoses.
探讨激素性股骨头坏死（ONFH）的临床特征。
2000 年 1 月至 2009 年 10 月，研究了 270 例激素性 ONFH 患者的 497 髋。患者入院时进行问卷调查，内容包括基础疾病、激素使用时间、激素总剂量、潜伏期（激素治疗开始至疼痛发作的时间间隔）、疼痛严重程度、首发部位、初步诊断、疼痛发作至最终诊断的时间间隔以及入院时的体格检查。分析疼痛与 Association Research Circulation Osseous（ARCO）分期、骨髓水肿（BME）和病变大小的相关性。
269 例患者开始使用激素至发生 ONFH 的中位数时间为 18 个月（范围，2-384 个月）。78.82%的病例在开始使用激素后 3 年内出现疼痛，仅 10.41%的患者在开始使用激素治疗 6 年或更长时间后首次出现疼痛。56 例（20.82%）误诊，最常见的误诊为腰椎疾病。56 例中有 51 例（91.07%）髋部压痛阳性，420 例有症状髋部中有 166 例（39.52%）出现关节活动受限。420 例有症状髋部中，C1 型 166 髋，C2 型 223 髋；299 髋出现塌陷；209 髋有 BME。
大多数激素性 ONFH 患者在开始激素治疗后 3 年内出现疼痛。疼痛与病变大小、塌陷和 BME 有关。疼痛部位不典型、体格检查不完善和 MRI 表现是误诊的主要原因。
