Sugano N, Ohzono K, Masuhara K, Takaoka K, Ono K
Department of Orthopaedic Surgery, Osaka University Medical School, Japan.
Clin Orthop Relat Res. 1994 Aug(305):190-9.
To detect and prognosticate osteonecrosis of the femoral head in the preradiographic stage, 60 patients with systemic lupus erythematosus who had normal hip radiology were followed prospectively for a mean period of 5 years (range, 3-7 years) using magnetic resonance imaging (MRI). The first MRI scans showed a low intensity band in the femoral head of normal fat intensity on T1 weighted images in 16 hips of 9 patients. The MRI findings were used to classify the lesions into three categories. Type A (six hips): the lesions occupied the medial one third or less of the weight bearing portion. Type B (two hips): the lesions occupied the medial two thirds or less of the weight bearing portion. Type C (eight hips): the lesions occupied more than the medial two thirds of the weight bearing portion. At the final followup, all of the Type A and one of the Type B hips were classified as being in Stage 1, and one Type B and two Type C hips had progressed to Stage 2. The MRI appearance of six Type C hips had changed from a band to an inhomogeneous pattern with the femoral head progressing to collapse on radiographs 2-5 years after the diagnosis of systemic lupus erythematosus. The remaining hips, which had been classified as normal at the first MRI, maintained a normal appearance, except for one hip that developed a Type A lesion. The presence of a low intensity band on T1 weighted images was an early specific finding of osteonecrosis of the femoral head, and extensive lesions demarcated by band images signified a poorer prognosis in systemic lupus erythematosus patients. If no MRI abnormalities appeared after 1 year of the startup treatment for systemic lupus erythematosus, there was little risk of femoral head collapse based on the subsequent clinical course of the patients followed in the current study.
为了在股骨头坏死的影像学前期阶段进行检测和预后评估，对60例髋关节X线检查正常的系统性红斑狼疮患者进行了前瞻性随访，平均随访时间为5年（范围3 - 7年），采用磁共振成像（MRI）。首次MRI扫描显示，在9例患者的16个髋关节中，T1加权图像上股骨头出现正常脂肪信号强度的低强度带。根据MRI表现将病变分为三类。A型（6个髋关节）：病变占据负重区内侧三分之一或更少。B型（2个髋关节）：病变占据负重区内侧三分之二或更少。C型（8个髋关节）：病变占据负重区内侧三分之二以上。在末次随访时，所有A型和1个B型髋关节被归类为1期，1个B型和2个C型髋关节已进展至2期。6个C型髋关节的MRI表现从带状变为不均匀模式，在系统性红斑狼疮诊断后2 - 5年，股骨头在X线片上出现塌陷。其余在首次MRI检查时被归类为正常的髋关节，除1个髋关节出现A型病变外，均保持正常外观。T1加权图像上出现低强度带是股骨头坏死的早期特异性表现，带状图像界定的广泛病变表明系统性红斑狼疮患者预后较差。如果在系统性红斑狼疮开始治疗1年后未出现MRI异常，根据本研究中患者的后续临床病程，股骨头塌陷的风险很小。
