Sonoda Kazuhiko, Yamamoto Takuaki, Motomura Goro, Hamai Satoshi, Karasuyama Kazuyuki, Kubo Yusuke, Iwamoto Yukihide
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan.
Springerplus. 2015 Nov 2;4:662. doi: 10.1186/s40064-015-1458-9. eCollection 2015.
Corticosteroid-induced osteonecrosis of the femoral head (ONFH) often affects both femoral heads. Such bilateral ONFH cases are generally detected concurrently on magnetic resonance imaging (MRI). On the other hand, in unilateral cases, it is rare that contralateral ONFH is subsequently detected. We herein report a case in which bilateral ONFH was detected in both femoral heads by repeated MRI examination at an interval of 6 weeks.
A 34-year-old man with purpura nephritis was started on corticosteroid therapy with prednisolone at 30 mg/day. Eight months after the initiation of corticosteroid therapy, he complained of left hip pain with no antecedent triggering activity. MRI obtained 8.5 months after the initiation of corticosteroid therapy showed the findings of osteonecrosis of the left femoral head, while no abnormalities were detected in the right femoral head. On the second MRI obtained 10 months after the initiation of corticosteroid treatment, however, osteonecrosis of the right femoral head was newly detected without an increase of the corticosteroid dose.
This case may indicate that corticosteroid-induced bilateral ONFH do not always develop at the same time.
糖皮质激素诱导的股骨头缺血性坏死（ONFH）常累及双侧股骨头。此类双侧ONFH病例通常在磁共振成像（MRI）上同时被检测到。另一方面，在单侧病例中，随后检测到对侧ONFH的情况很少见。我们在此报告一例通过间隔6周重复进行MRI检查在双侧股骨头均检测到ONFH的病例。
一名34岁患有紫癜性肾炎的男性开始接受泼尼松龙30毫克/天的糖皮质激素治疗。糖皮质激素治疗开始8个月后，他主诉左髋疼痛，无先前诱发活动。糖皮质激素治疗开始8.5个月后进行的MRI显示左股骨头存在缺血性坏死表现，而右股骨头未检测到异常。然而，在糖皮质激素治疗开始10个月后进行的第二次MRI检查中，在未增加糖皮质激素剂量的情况下新检测到右股骨头缺血性坏死。
该病例可能表明糖皮质激素诱导的双侧ONFH并非总是同时发生。
