Relationship between bone marrow edema and development of symptoms in patients with osteonecrosis of the femoral head
Relationship between bone marrow edema and development of symptoms in patients with osteonecrosis of the femoral head
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DOI：
10.2214/ajr.05.0086
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发表时间：
2006-06-01
影响因子：
5
通讯作者：
Minami, Akio
中科院分区：
文献类型：
--
作者：
Ito, Hiroshi;Matsuno, Takeo;Minami, Akio
OBJECTIVE.本研究的目的是确定危险因素对预测股骨头坏死患者预后的意义。前瞻性随访了61例连续患者的83个无症状或轻微症状髋关节。入选标准包括通过典型MRI结果确定的股骨头坏死，无塌陷进展的放射学证据，Harris髋关节评分≥ 85分。每三个月一次。患者接受了临床和放射学检查，并在6至12个月的时间间隔内获得了MR图像。随访持续至髋关节疼痛恶化，Harris髋关节评分小于70分或手术。无症状髋关节随访至少24个月。首次诊断后的平均临床和影像学随访期为60个月（范围，3-168个月）。末次随访时，83例髋关节中有36例（43%）出现症状。在随访期间，28个髋关节（34%）出现骨髓水肿。28个髋关节中有27个（96%）有症状，骨髓水肿与髋关节疼痛恶化显著相关（p < 0.0001）。有骨髓水肿组坏死体积明显大于无骨髓水肿组（P < 0.0001）。发现骨髓水肿是疼痛恶化的最显著危险因素（p < 0.0001）。骨髓水肿与坏死体积密切相关，是髋关节疼痛恶化的最重要危险因素。30%或以上的大坏死体积可能是预测髋关节疼痛未来恶化的第二个有用指标。
OBJECTIVE. The purpose of this study was to determine the significance of risk factors on MR images for predicting the outcome of patients with osteonecrosis of the femoral head.SUBJECTS AND METHODS. Eighty-three asymptomatic or minimally symptomatic hips in 61 consecutive patients were followed up prospectively. Inclusion criteria included osteonecrosis of the femoral head identified by typical MRI findings, with no radiographic evidence of progression of collapse, and Harris hip score of 85 points or more. Every 3 months. the patients underwent clinical and radiographic examination, and MR images were obtained at 6- to 12-month intervals. Follow-up continued until worsening of hip pain with Harris hip score of less than 70 points or surgery. Asymptomatic hips were followed up for at least 24 months. The mean clinical and radiographic follow-up period after the initial diagnosis was 60 months (range, 3-168 months).RESULTS. Thirty-six (43%) of the 83 hips were symptomatic at the last follow-up. Bone marrow edema was present in 28 hips (34%) during the follow-up period. Twenty-seven (96%) of the 28 hips were symptomatic, and bone marrow edema significantly correlated with worsening of hip pain (p < 0.0001). The necrotic volume of hips with bone marrow edema was significantly larger than those without bone marrow edema (p < 0.0001). Bone marrow edema was found to be the most significant risk factor for worsening of pain (p < 0.0001).CONCLUSION. Bone marrow edema strongly con-elated with necrotic volume and was the most significant risk factor for worsening of hip pain. A large necrotic volume of 30% or more may be the second useful indicator for predicting future worsening of hip pain.