Cruess R L
Clin Orthop Relat Res. 1978 Jan-Feb(130):86-93.
Nineteen of 97 patients with steroid-induced osteonecrosis had a lesion involving the head of the humerus, on one or both sides. The lesion usually began as a subchondral osteolytic area which often progresses to collapse. Articular cartilage separated from subchondral bone, either becoming detached as a free cap or at a later stage reattaching. Present evidence suggests that osteonecrosis of the femoral or humeral head should properly be classified as either traumatic (macrovascular injury) or embolic (microvascular injury) in nature. In 14 patients conservative treatment resulted in satisfactory function with only intermittent symptoms, and including pendulum exercises and avoidance of abduction, particularly against resistance. Five patients required replacement of 6 humeral head replacement arthroplasties with Neer's prosthesis.
97例类固醇诱导性骨坏死患者中，19例出现一侧或双侧肱骨头部病变。病变通常始于软骨下骨溶解区，常进展为塌陷。关节软骨与软骨下骨分离，要么作为游离帽状脱落，要么在后期重新附着。目前的证据表明，股骨头或肱骨头骨坏死本质上应正确分类为创伤性（大血管损伤）或栓塞性（微血管损伤）。14例患者采用保守治疗，功能满意，仅出现间歇性症状，包括钟摆运动和避免外展，尤其是抗阻力外展。5例患者需要用Neer假体进行6次肱骨头置换关节成形术。
