Mulliken B D, Renfrew D L, Brand R A, Whitten C G
Department of Orthopaedic Surgery, University of Iowa, Iowa City 52242, USA.
Iowa Orthop J. 1994;14:115-9.
We performed limited MRI exams of the hips of renal transplant patients to determine the prevalence of osteonecrosis (ON) and the natural history of early lesions. Of 132 subjects, ten patients and 15 hips were considered positive for ON (prevalence = 7.6%, bilaterality = 50%). Eleven of the MRI-positive hips were Ficat Stage 0 (asymptomatic, pre-radiographic) and were followed with serial radiographs and MRI exams. With an average follow-up of 22 months, only one of these early lesions progressed beyond Ficat 0. The other ten hips neither developed progressive MRI changes nor progressed to radiographic stages. Although our follow-up of 22 months is short, the results suggest that early ON may have a benign course in many cases. This supports the recent work of Kopecky et al., who found that many early lesions in renal transplant patients seemingly stabilize or disappear. While the prevalence was lower than in some previous reports, a significant number of patients did demonstrate previously unsuspected disease. Given the recent reports of poor results and high complication rates using "prophylactic" surgery such as core decompression for early ON, we recommend further study into the natural history of these lesions to assess the need for such procedures. In addition, we describe the use of a simple, quick and cost-effective method to screen high risk patients for early ON.
我们对肾移植患者的髋关节进行了有限的磁共振成像（MRI）检查，以确定骨坏死（ON）的患病率以及早期病变的自然病程。在132名受试者中，10名患者和15个髋关节被认为ON呈阳性（患病率=7.6%，双侧性=50%）。11个MRI阳性的髋关节处于Ficat 0期（无症状，影像学前期），并通过系列X线片和MRI检查进行随访。平均随访22个月后，这些早期病变中只有1个进展超过Ficat 0期。其他10个髋关节既未出现MRI的进展性改变，也未进展到影像学分期。虽然我们22个月的随访时间较短，但结果表明，在许多情况下早期ON可能具有良性病程。这支持了Kopecky等人最近的研究工作，他们发现肾移植患者的许多早期病变似乎会稳定或消失。虽然患病率低于一些先前的报告，但仍有相当数量的患者确实表现出先前未被怀疑的疾病。鉴于最近有报道称，对于早期ON采用诸如髓芯减压等“预防性”手术效果不佳且并发症发生率高，我们建议进一步研究这些病变的自然病程，以评估此类手术的必要性。此外，我们描述了一种简单、快速且经济高效的方法，用于筛查早期ON的高危患者。
