Nawata Kento, Nakamura Junichi, Hagiwara Shigeo, Wako Yasushi, Miura Michiaki, Kawarai Yuya, Sugano Masahiko, Yoshino Kensuke, Inage Kazuhide, Orita Sumihisa, Ohtori Seiji
Department of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, Chiba, Japan.
Chiba Aoba Municipal Hospital, Chiba, Japan.
Mod Rheumatol. 2020 May;30(3):586-591. doi: 10.1080/14397595.2019.1623363. Epub 2019 Jul 31.
The goals of this study were to elucidate the distribution of multifocal osteonecrosis associated with glucocorticoid therapy using magnetic resonance imaging (MRI) and to establish a MRI screening method. Between 1986 and 2018, 107 patients underwent MRI screening of their hips, knees, shoulders and ankle joints (856 joints in total) after systemic glucocorticoid therapy. Osteonecrosis was observed in hip (68%), knee (44%), ankle (17%) and shoulder (15%) joints. Patients with bilateral osteonecrosis in their hips were likely to have bilateral osteonecrosis in their knees, whereas patients without osteonecrosis in both hips were unlikely to have osteonecrosis in both knees ( = .0299). Osteonecrosis was never evident in the ankle or shoulder joints when a patient did not have osteonecrosis in both hip and knee joints. In this study, MRI - as a screening method for multifocal osteonecrosis associated with glucocorticoid therapy - showed the sites affected first are hips and knees followed by ankles and shoulders. If osteonecrosis is absent in hip and knee joints, further screening of the ankles and shoulders is unnecessary. Any osteonecrosis observed in the hip and/or the knee joints warrants a second MRI screening of the ankles and shoulders.
本研究的目的是利用磁共振成像（MRI）阐明与糖皮质激素治疗相关的多灶性骨坏死的分布情况，并建立一种MRI筛查方法。1986年至2018年期间，107例患者在接受全身糖皮质激素治疗后，对其髋、膝、肩和踝关节进行了MRI筛查（共856个关节）。在髋（68%）、膝（44%）、踝（17%）和肩（15%）关节观察到骨坏死。髋部双侧发生骨坏死的患者，其膝部可能双侧发生骨坏死；而髋部无骨坏死的患者，其膝部双侧发生骨坏死的可能性较小（P = 0.0299）。当患者髋部和膝部均无骨坏死时，踝关节或肩关节从未出现明显的骨坏死。在本研究中，作为与糖皮质激素治疗相关的多灶性骨坏死的筛查方法，MRI显示首先受影响的部位是髋部和膝部，其次是踝部和肩部。如果髋部和膝部没有骨坏死，则无需进一步筛查踝部和肩部。在髋部和/或膝部观察到的任何骨坏死都需要对踝部和肩部进行第二次MRI筛查。
