Davidson J K, Tsakiris D, Briggs J D, Junor B J
Clin Radiol. 1985 Jan;36(1):27-35. doi: 10.1016/s0009-9260(85)80012-x.
Skeletal radiological surveys in 161 renal transplant recipients identified 36 patients with 115 lesions of osteonecrosis. A further two patients with osteonecrosis found at autopsy had had no radiographic abnormality. The total incidence of osteonecrosis was, therefore, 38 (24%) out of 161. The lesions were frequently multiple and bilateral with structural failure being the most common initial abnormality and the femoral head the most frequent site. Lesions also occurred in the femoral condyles, the talus, the humeral heads and the metatarsals, many being symptom-free. Calcification was demonstrated in the femoral and tibial shafts. The initial radiological abnormality appeared at a mean interval of 19 months after transplant but could occur as late as 75 months. Significantly fewer patients, three (7%) out of 41, developed osteonecrosis following a low-dose prednisolone regimen (0.8 g) compared with a high-dose group (2.8 g) where 35 (29%) out of 120 were affected. More females than males developed osteonecrosis, but no correlation could be demonstrated with regard to age, primary renal disease, number and type of transplant and duration of dialysis prior to transplant. Osteonecrosis is a complication which can be reduced with a low-dose prednisolone regimen. Most lesions will be demonstrated by radiological survey undertaken during the second and fourth years after transplantation.
对161例肾移植受者进行的骨骼放射学检查发现，36例患者有115处骨坏死病变。另外在尸检中发现的2例骨坏死患者生前影像学检查无异常。因此，161例患者中骨坏死的总发生率为38例（24%）。病变常为多发且双侧出现，结构破坏是最常见的初始异常，股骨头是最常受累部位。股骨髁、距骨、肱骨头和跖骨也会出现病变，许多患者无症状。股骨和胫骨干可见钙化。最初的放射学异常出现在移植后平均19个月，但最晚可在75个月出现。与高剂量组（2.8 g）相比，低剂量泼尼松龙方案（0.8 g）治疗的41例患者中发生骨坏死的患者明显较少，仅3例（7%），而高剂量组120例中有35例（29%）受累。女性发生骨坏死的人数多于男性，但骨坏死与年龄、原发性肾病、移植次数和类型以及移植前透析时间无关。骨坏死是一种并发症，低剂量泼尼松龙方案可降低其发生率。大多数病变可通过移植后第二和第四年进行的放射学检查发现。
