Fink B, Assheuer J, Enderle A, Schneider T, Rüther W
Orthopaedic Department, University of Hamburg, Germany.
Skeletal Radiol. 1997 Sep;26(9):509-16. doi: 10.1007/s002560050277.
To investigate the possible occurrence of osteonecrosis in the acetabulum in patients with non-traumatic necrosis of the femoral head.
One hundred and seventy-nine patients with non-traumatic femoral head necrosis were assessed by MRI and radiography for the presence of acetabular necrosis. Three criteria were established to differentiate between osteonecrosis and osteoarthritic changes: (1) heterogeneous morphology and irregular contours of the lesion; (2) typical demarcation lines of osteonecrosis; (3) deficient accumulation of intravenous gadolinium in the affected regions.
In four patients histological confirmation of acetabular necrosis was obtained. The MR analysis of 22 acetabula (9.5% of those examined) showed changes which suggested osteonecrosis. No cystic lesions were demonstrated in the subchondral bone of any patient. Two cases of acetabular necrosis were found without an ipsilateral femoral head necrosis. In two patients of the 14 who had undergone total hip replacement following necrosis of the femoral head, aseptic loosening of the acetabular component was found.
The study suggests that acetabular necrosis may be an accompaniment to aseptic necrosis of the femoral head. Further work is required to assess its importance in premature loosening of the acetabular element of total hip arthroplasty.
探讨非创伤性股骨头坏死患者髋臼发生骨坏死的可能性。
对179例非创伤性股骨头坏死患者进行MRI和X线检查，以评估髋臼坏死情况。确立了三项区分骨坏死与骨关节炎改变的标准：（1）病变形态不均一且轮廓不规则；（2）典型的骨坏死分界线；（3）受累区域静脉注射钆剂摄取不足。
4例患者获得髋臼坏死的组织学证实。对22个髋臼（占检查髋臼的9.5%）的MR分析显示有提示骨坏死的改变。所有患者的软骨下骨均未显示囊性病变。发现2例髋臼坏死患者无同侧股骨头坏死。在14例股骨头坏死行全髋关节置换术的患者中，有2例出现髋臼假体无菌性松动。
该研究提示髋臼坏死可能是股骨头无菌性坏死的伴随病变。需要进一步研究以评估其在全髋关节置换术髋臼部件过早松动中的重要性。
