Laroche M, Costa L, Bernard J, Puget J, Constantin A, Cantagrel A, Mazières B
Rheumatology Department, Rangueil Teaching Hospital, Toulouse, France.
Rev Rhum Engl Ed. 1998 Jun;65(6):393-6.
Osteonecrosis of the hip classically produces a heterogeneous density in the femoral head, although the bone marrow ischemia extends down to the femoral neck and trochanters. Also, bone insufficiency fractures due to diffuse bone loss have been implicated in the genesis of osteonecrosis.
To use dual-energy X-ray absorptiometry to quantify the bone changes produced by osteonecrosis of the hip and to compare bone mineral density values in patients with osteonecrosis of the hip and in controls.
Bone mineral density was measured at the femoral neck (total femoral neck, Ward's triangle, and trochanter), femoral head and lumbar spine using dual-energy X-ray absorptiometry (DPX, L Lunar) in 22 patients with osteonecrosis of the hip and in 22 age- and sex-matched controls.
In the patients with osteonecrosis, bone mineral density on the affected side was higher than on the opposite side at the femoral head (+18%), femoral neck (+7%), and Ward's triangle (+6%) and lower at the trochanter (-4%). These differences were most marked at the more advanced end of the osteonecrosis spectrum. As compared to age-specific normative values, the osteonecrosis patients had moderately decreased bone mineral density values at the lumbar spine (-0.53 +/- 1.1 SD or -6 +/- 1.5%) and at the femoral neck on the normal side (-0.9 +/- 1.4 SD or 12 +/- 1.8%). As compared to the controls, bone mineral density was significantly decreased at Ward's triangle (-25%; P: 0.04) and nonsignificantly decreased at the lumbar spine (-4.7%; P: 0.15) and at the femoral neck (-15%; P: 0.09).
尽管骨髓缺血会延伸至股骨颈和转子，但典型的髋部骨坏死会在股骨头产生不均匀密度。此外，弥漫性骨质流失导致的骨质不全性骨折也被认为与骨坏死的发生有关。
使用双能X线吸收法量化髋部骨坏死产生的骨质变化，并比较髋部骨坏死患者与对照组的骨密度值。
使用双能X线吸收法（DPX，Lunar公司）对22例髋部骨坏死患者及22例年龄和性别匹配的对照组进行测量，测量部位包括股骨颈（全股骨颈、沃德三角区和转子）、股骨头和腰椎。
在骨坏死患者中，患侧股骨头（+18%）、股骨颈（+7%）和沃德三角区（+6%）的骨密度高于对侧，而转子处（-4%）则较低。这些差异在骨坏死谱的更晚期最为明显。与年龄特异性标准值相比，骨坏死患者腰椎（-0.53±1.1标准差或-6±1.5%）和正常侧股骨颈（-0.9±1.4标准差或-12±1.8%）的骨密度值适度降低。与对照组相比，沃德三角区骨密度显著降低（-25%；P：0.04），腰椎（-4.7%；P：0.15）和股骨颈（-15%；P：0.09）骨密度降低不显著。
