Osteonecrosis of the femoral head associated with pregnancy - A preliminary report
Osteonecrosis of the femoral head associated with pregnancy - A preliminary report
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DOI：
10.2106/00004623-199906000-00006
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发表时间：
1999-06-01
影响因子：
5.3
通讯作者：
Urbaniak, JR
中科院分区：
文献类型：
--
作者：
Montella, BJ;Nunley, JA;Urbaniak, JR
骨坏死通常与创伤、皮质类固醇的使用或酒精滥用有关。我们调查了股骨头坏死与妊娠之间的罕见联系，并确定了妊娠妇女与未妊娠育龄妇女之间的差异。在至少随访2年后，根据疼痛缓解和Harris髋关节评分的改善，对带血管游离腓骨移植治疗的结果进行了评价。方法：13名妇女（17个髋关节）在怀孕期间或分娩后的前四周内出现髋关节疼痛，疼痛一直持续到根据磁共振成像诊断为股骨头坏死。没有患者有这种疾病的任何其他风险因素。通过临床评估、审查记录和X线照片以及电话调查获得信息。11名女性（15个髋关节）接受了带血管蒂的游离腓骨移植，其中9名（11个髋关节）在术后至少2年进行了疼痛缓解和Harris髋关节评分评价。结果：疼痛开始时的平均年龄为31.5岁（范围：25 ~ 41岁）。13名妇女中有11名是早孕，患者通常在妊娠中期或妊娠晚期首次出现疼痛。这些女性在怀孕期间往往身材矮小，体重增加相对较多。13例患者中8例有下肢肿胀和静脉曲张。诊断平均延迟10.3个月，范围为3至30个月。常见的误诊是妊娠期髋关节一过性骨质疏松症。所有髋关节的正确诊断都是基于磁共振成像上双密度信号的发现或X线平片上疾病进展的证据。根据Marcus等的系统，诊断时的分期范围为II至V。所有妇女均累及左侧髋关节，在11名女性（15个髋关节）接受带血管游离腓骨移植的患者中，9名患者术前疼痛明显或完全缓解。1例进行性疼痛患者的2个髋关节接受了全髋关节置换术，2个髋关节（1例患者）失访，9例患者（11个髋关节）至少随访2年，Harris髋关节评分平均改善24分。结论：偶尔，妊娠期间开始的髋关节疼痛是由股骨头坏死引起的。高怀疑指数和磁共振成像的使用可能会导致早期诊断和更好的预后，在这一人群的妇女。在这项研究中，带血管的游离腓骨移植是一种有效的选择，可以延缓或推迟全髋关节置换术的需要。
Background Osteonecrosis is usually associated with trauma, use of corticosteroids, or alcohol abuse. We investigated the rare association of osteonecrosis of the femoral head and pregnancy, and we defined differences between the disorder in pregnant women and that in women of childbearing age who were not pregnant, The results of treatment with a free vascularized fibular graft were evaluated in terms of relief of pain and improvement of the Harris hip score after a minimum of two years of follow-up.Methods: Thirteen women (seventeen hips) had the onset of pain in the hip during pregnancy or within the first four weeks after delivery, and the pain persisted until a diagnosis of osteonecrosis of the femoral head was made on the basis of magnetic resonance imaging. No patient had any other risk factor for this disease. Information was obtained by means of clinical assessment, a review of the records and radiographs, and a telephone survey. Eleven women (fifteen hips) were managed with a free vascularized fibular graft, and nine of them (eleven hips) were evaluated, with regard to relief of pain and the Harris hip score, at a minimum of two years postoperatively,Results: The average age when the pain began was 31.5 years (range, twenty-five to forty-one years). Eleven of the thirteen women were primigravid, and the patients typically first had the pain late in the second trimester or in the third trimester of pregnancy. The women tended to have a small body frame and a relatively large weight gain during the pregnancy. Eight of the thirteen patients had swelling and varicosity of the lower extremities. The diagnosis was delayed an average of 10.3 months, with a range of three to thirty months. A common misdiagnosis was transient osteoporosis of the hip during pregnancy, A correct diagnosis was established for all hips on the basis of the finding of a double-density signal on magnetic resonance imaging or evidence of progression of the dis-ease on plain radiographs, According the system of Marcus et al,, the stage at the time of diagnosis ranged from II to V, All women had involvement of the left hip, and four had bilateral involvement.Of the eleven women (fifteen hips) who were managed with a free vascularized fibular graft, nine noted marked or complete relief of the preoperative pain. Two hips in a patient who had progressive pain were treated with a total hip arthroplasty, Two hips (one patient) were lost to follow-up, The nine patients (eleven hips) who were available for follow-up at a minimum of two years had an average improvement in the Harris hip score of 24 points,Conclusions: Occasionally, pain in the hip that begins during pregnancy is caused by osteonecrosis of the femoral head. A high index of suspicion and use of magnetic resonance imaging may lead to an earlier diagnosis and a better prognosis in this population of women. In this study, treatment with a free vascularized fibular graft was a useful option with which to obviate or postpone the need for total hip arthroplasty.