Kekatpure Aashay L, Sun Ji-Ho, Sim Gyeong-Bo, Chun Jae-Myeung, Jeon In-Ho
Department of Orthopedic Surgery, Asan Medical Center, School of Medicine, University of Ulsan, Seoul, South Korea.
Department of Orthopedic Surgery, Asan Medical Center, School of Medicine, University of Ulsan, Seoul, South Korea.
J Shoulder Elbow Surg. 2015 Jun;24(6):922-7. doi: 10.1016/j.jse.2014.10.020. Epub 2014 Dec 26.
Rapidly destructive arthrosis of the humeral head is a rare condition with an elusive pathophysiologic mechanism. In this study, radiographic and histopathologic findings were analyzed to determine the clinical characteristics of this rare condition.
We retrospectively analyzed 189 patients who underwent total shoulder arthroplasty from January 2001 to August 2012. Among them, 9 patients showed a particular pattern of rapid collapse of the humeral head on plain radiography and magnetic resonance imaging (MRI) within 12 months from symptom onset. Patients with trauma, rheumatoid arthritis, steroid intake, neurologic osteoarthropathy, osteonecrosis, renal osteoarthropathy, or gout were excluded.
All patients were women, with a mean age of 72.0 years (range, 63-85 years). The right side was involved in 7 cases and the left in 2 cases. The mean duration of humeral head collapse was 5.6 months (range, 2-11 months) from the onset of shoulder pain. Plain radiographs of all patients showed a unique pattern of humeral head flattening, which appeared like a clean surgical cut with bone debris around the humeral head. MRI findings revealed significant joint effusion and bone marrow edema in the humeral head, without involvement of the glenoid. Pathologic findings showed both fragmentation and regeneration of bone matrix, representing fracture healing.
The important features of rapidly destructive shoulder arthrosis are unique flattened humeral head collapse with MRI showing massive joint effusion and bone marrow edema in the remnant humeral head. This condition should be considered in the differential diagnosis of elderly women with insidious shoulder pain.
肱骨头快速破坏性关节病是一种罕见疾病，其病理生理机制尚不明确。本研究通过分析影像学和组织病理学表现来确定这种罕见疾病的临床特征。
我们回顾性分析了2001年1月至2012年8月期间接受全肩关节置换术的189例患者。其中，9例患者在症状出现后12个月内，在X线平片和磁共振成像（MRI）上表现出肱骨头快速塌陷的特殊模式。排除有创伤、类风湿关节炎、使用类固醇、神经性骨关节炎、骨坏死、肾性骨关节炎或痛风的患者。
所有患者均为女性，平均年龄72.0岁（范围63 - 85岁）。右侧受累7例，左侧受累2例。从肩部疼痛发作到肱骨头塌陷的平均持续时间为5.6个月（范围2 - 11个月）。所有患者的X线平片均显示肱骨头扁平的独特模式，看起来像是肱骨头周围有骨碎片的整齐手术切口。MRI表现显示肱骨头有明显的关节积液和骨髓水肿，关节盂未受累。病理结果显示骨基质既有碎裂又有再生，代表骨折愈合。
快速破坏性肩关节病的重要特征是肱骨头独特的扁平塌陷，MRI显示残留肱骨头有大量关节积液和骨髓水肿。对于隐匿性肩部疼痛的老年女性进行鉴别诊断时应考虑这种疾病。
