Steinberg M E, Hayken G D, Steinberg D R
Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia 19104.
J Bone Joint Surg Br. 1995 Jan;77(1):34-41.
Much of the current confusion and contradiction on the treatment of avascular necrosis of the femoral head is caused by the lack of an agreed efficient, quantitative system for evaluation and staging. We have used a new system to evaluate over 1000 hips with avascular necrosis during a period of 12 years; it has proved to be very valuable. The system is based on the sequence of pathological events known to take place. It allows accurate quantification in both early and later stages, does not use older, invasive diagnostic procedures, and incorporates the newer techniques of bone scanning and MRI. Clinical records of pain and reduced function are not a specific part of the system, although they help to determine treatment and outcome. Hips are first placed into one of seven stages from 0 to VI, based upon the type of radiological change. The extent of involvement is then measured. This allows more accurate evaluation of progression or resolution and better comparison of different methods of management. The system also helps to provide a prognosis and to decide on the best available method of treatment.
目前在股骨头缺血性坏死治疗方面存在的诸多困惑和矛盾，是由于缺乏一个公认的有效、定量的评估和分期系统所致。在12年的时间里，我们使用一种新系统对1000余例股骨头缺血性坏死的髋关节进行了评估；事实证明该系统非常有价值。该系统基于已知发生的病理事件序列。它能在早期和晚期阶段都进行准确量化，不采用较陈旧的侵入性诊断程序，还纳入了骨扫描和MRI等新技术。疼痛和功能减退的临床记录并非该系统的特定组成部分，尽管它们有助于确定治疗方案和预后。髋关节首先根据放射学改变的类型被归入从0到VI的七个阶段之一。然后测量受累范围。这能更准确地评估病情进展或好转情况，并更好地比较不同的治疗方法。该系统还有助于提供预后信息并决定最佳的可用治疗方法。
