a Department of Children and Adolescents , Oulu University Hospital , Oulu , Finland.
b PEDEGO Research Unit, University of Oulu , Oulu , Finland.
Acta Oncol. 2019 Apr;58(4):505-511. doi: 10.1080/0284186X.2019.1566769. Epub 2019 Jan 30.
In patients with cancer, osteonecrosis (ON) lesions can affect multiple sites throughout the skeleton, including the long and short bones and the joints. The aims of this study were to explore the natural course of ON in patients treated for cancer by using radiological classification suitable for multisite ON lesions and to assess correlations between the ON grade and surgical procedures.
Data were retrieved from hospital databases on 233 ON lesions in 54 patients (aged 2-73 years at cancer diagnosis; mean age: 25 years). ONs were graded according to the Niinimäki classification, based on magnetic resonance images. Medical records were reviewed to identify surgical procedures.
A total of 14 different ON sites were detected; the hip was the most common site (n = 51), followed by the femur (n = 45), tibia (n = 41) and knee (n = 37). Among the 233 ON lesions, 78.1% did not require surgical procedures. The remaining lesions required total joint arthroplasty (TJA; 40/233, 17.2%), core decompression (3.4%) and arthroscopy (1.3%). Most TJAs (33/40, 82.5%) were performed on the hip. ONs of the knee required TJAs only once; grade 3 knee ONs frequently healed (58%, 11/19). None of the diaphyseal or metaphyseal (grade 1-2) ONs of the long bones required surgery, and no fractures of those bones were identified.
In conclusion, the natural history of ONs varied by the grade and site. Based on our findings, we would not recommend routine radiological follow-ups for grades 1-2 ON lesions that do not affect the joints, because the clinical consequences of those lesions appear to be minimal, although pain relief would be warranted. In contrast, joint deformations (grade 5) require surgery; therefore, intervention studies should focus on grades 3-4 ON lesions.
在癌症患者中，骨坏死（ON）病变可影响骨骼的多个部位，包括长骨和短骨以及关节。本研究旨在通过使用适合多部位 ON 病变的放射学分类来探索癌症治疗后患者 ON 的自然病程，并评估 ON 分级与手术程序之间的相关性。
从 54 名患者（癌症诊断时年龄为 2-73 岁；平均年龄：25 岁）的医院数据库中检索到 233 处 ON 病变的数据。根据磁共振成像，根据 Niinimäki 分类对 ON 进行分级。回顾病历以确定手术程序。
共发现 14 个不同的 ON 部位；髋关节最常见（n=51），其次是股骨（n=45）、胫骨（n=41）和膝关节（n=37）。在 233 处 ON 病变中，78.1%无需手术。其余病变需要全关节置换术（TJA；233/40，17.2%）、核心减压术（3.4%）和关节镜检查（1.3%）。大多数 TJA（33/40，82.5%）在髋关节进行。膝关节的 ON 仅需进行一次 TJA；膝关节 3 级 ON 经常愈合（58%，19/11）。长骨的骨干或干骺端（1-2 级）的 ON 均无需手术，也未发现这些骨的骨折。
总之，ON 的自然病程因分级和部位而异。根据我们的发现，我们不建议对不影响关节的 1-2 级 ON 病变进行常规影像学随访，因为这些病变的临床后果似乎很小，尽管需要缓解疼痛。相比之下，关节畸形（5 级）需要手术；因此，干预研究应侧重于 3-4 级 ON 病变。
