早期诊断和治疗激素性股骨头坏死。

Early diagnosis and treatment of steroid-induced osteonecrosis of the femoral head.

机构信息

Department of Orthopedics, The Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China.

出版信息

Int Orthop. 2019 May;43(5):1083-1087. doi: 10.1007/s00264-018-4011-y. Epub 2018 Jun 6.

DOI:10.1007/s00264-018-4011-y

PMID:29876626

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7079928/

Abstract

OBJECTIVE

This study aims to investigate the early diagnosis and treatment of steroid-induced osteonecrosis of the femoral head.

PATIENTS AND METHODS

From January 2010 to January 2014, a total of 350 patients, who required the use of large amounts of hormones, were enrolled into the study. These patients were followed up every three months after starting the hormone therapy. A total of 62 cases were screened, among which nine cases were asymptomatic. Furthermore, 38 patients were diagnosed as stage I and were given low-molecular weight heparin (LMWH) and vasodilator drugs. Moreover, 22 cases were diagnosed as stage IIa/b and underwent core decompression. In addition, two cases were diagnosed as stage IIc and underwent pedicled bone transplantation. During the follow-up period, ARCO staging was used for radiological evaluation, the HHS score was applied to evaluate for clinical efficacy, and SPSS 22.0 statistical software was used for the data analysis.

RESULTS

A total of 60 patients were followed up for 24 months. Among these patients, 38 patients were diagnosed with ARCO stage I and underwent systematic therapy. No progress was found in 29 cases (76.3%). Furthermore, three cases progressed to stage IIb (7.8%), four cases progressed to stage IIc (10.5%), two cases progressed to stage III and IV, respectively (2.6%), and 16 cases (80%) did not progress after core decompression. In the 16 cases at stage IIa and four cases at stage IIb, and four cases (20%) progressed in stage III. The HHS score of stage I was 80.42 ± 3.25 before follow-up, while the HHS score was 86.46 ± 8.54 after follow-up, and the difference was statistically significant (P < 0.05). Furthermore, the HHS score of patients with stage IIa/b was 70.38 ± 4.62 before follow-up, while the HHS score was 80.28 ± 6.72 after follow-up, and the difference was statistically significant (P < 0.01).

CONCLUSION

MRI remains as the most effective method for the non-invasive diagnosis of osteonecrosis, at present. Enhanced MRI may be able to detect early osteonecrosis, but further research is needed. Drug treatment and core decompression can achieve satisfactory results at the early stage.

摘要

目的

本研究旨在探讨激素性股骨头坏死的早期诊断和治疗。

患者与方法

2010 年 1 月至 2014 年 1 月，共纳入 350 例需要大量激素治疗的患者。这些患者在开始激素治疗后每 3 个月进行一次随访。共筛选出 62 例，其中 9 例无症状。此外，38 例患者被诊断为 I 期，并给予低分子肝素（LMWH）和血管扩张剂治疗。此外，22 例患者被诊断为 IIa/b 期，并接受了核心减压术。另外，2 例患者被诊断为 IIc 期，并接受了带蒂骨移植。在随访期间，采用 ARCO 分期进行影像学评估，HHS 评分评估临床疗效，采用 SPSS 22.0 统计软件进行数据分析。

结果

60 例患者随访 24 个月。其中，38 例患者被诊断为 ARCO Ⅰ期，并接受系统治疗。29 例（76.3%）无进展。此外，3 例进展为 IIb 期（7.8%），4 例进展为 IIc 期（10.5%），2 例分别进展为 III 期和 IV 期（2.6%），16 例（80%）接受核心减压后无进展。在 16 例 IIa 期和 4 例 IIb 期患者中，有 4 例（20%）进展为 III 期。I 期患者随访前 HHS 评分为 80.42±3.25，随访后 HHS 评分为 86.46±8.54，差异有统计学意义（P<0.05）。此外，IIa/b 期患者随访前 HHS 评分为 70.38±4.62，随访后 HHS 评分为 80.28±6.72，差异有统计学意义（P<0.01）。