Magnetic Resonance Imagery Of Hip Avascular Necrosis

髋关节缺血性坏死（AVN）在HIV感染时有报道。1999年5月，我们在两名患者中诊断出AVN后，我们开始担心hiv感染患者发生AVN的风险可能比之前认识到的要高。为了检验这一点，我们对无症状hiv感染患者进行了一项基于磁共振成像（MRI）的研究，以确定临床人群中髋关节AVN的患病率。339例患者中有15例（4.4%）MRI显示AVN: 6例为双侧受累，9例为单侧受累。118名hiv阴性志愿者均无AVN的MRI证据。前瞻性的身体检查不能区分hiv感染的AVN患者和没有AVN的患者。骨坏死患者比非骨坏死患者更有可能使用皮质类固醇、降脂剂和睾酮，并且更有可能通过健身进行常规锻炼。因此，HIV-1感染应包括在易导致骨坏死的医疗条件中。该队列正在进行长期随访，以确定有症状和无症状病变的自然史，以及新病变的发生率。

Avascular necrosis (AVN) of the hip has occasionally been reported in the setting of HIV infection. After we diagnosed AVN in two patients in May 1999, we became concerned that HIV-infected patients may be at higher risk for developing AVN than previously recognized. To examine this, we undertook a magnetic resonance imaging (MRI)-based study of asymptomatic HIV-infected patients to determine the prevalence of hip AVN in our clinic population. 15 of 339 (4.4 percent) patients had evidence of AVN by MRI: six had bilateral and nine had unilateral involvement. None of 118 HIV-negative volunteers had MRI evidence of AVN. Prospectively performed physical examinations did not distinguish HIV-infected patients with AVN from those without. Patients with osteonecrosis were more likely than patients without osteonecrosis to have used corticosteroids, lipid-lowering agents, and testosterone, and were more likely to routinely exercise by bodybuilding. Thus, HIV-1 infection should be included among medical conditions that predispose to the development of osteonecrosis. Long-term followup of this cohort is underway to determine the natural history of symptomatic and asymptomatic lesions, and the incidence of new lesions.