骨髓水肿与股骨头塌陷及疼痛的相关性研究

The correlation between bone marrow edema,collapse and pain in osteonecrosis of the femoral head

目的 探讨股骨头缺血性坏死骨髓水肿的发生机制及其与疼痛程度和塌陷的关系.方法 对2006年1月至200r7年10月资料齐全的股骨头缺血性坏死患者共91例(165髋)进行回顾性分析,改良Merle d'Aubigne评分统计每髋的疼痛程度.并对16例(16髋)有骨髓水肿的患者行MRI随访.结果 165髋中47髋出现骨髓水肿,发生于ARCO分期Ⅱ期13髋,Ⅲ期34髋,各期出现骨髓水肿差异有统计学意义(P＜0.05).T2加权像和STIR像均出现骨髓水肿37髋,仅STIR像出现骨髓水肿10髋.40髋骨髓水肿在症状出现后6个月内发现.7髋骨髓水肿在症状出现后7～15个月内发现.Ⅱ期髋关节,伴骨髓水肿者平均疼痛评分为2.46±0.66,无骨髓水肿者为5.21±1.12,疼痛评分差异有统计学意义(P＜0.05).Ⅲ期髋关节,伴骨髓水肿者平均疼痛评分为2.38±0.78,无骨髓水肿者为3.63±0.93,疼痛评分差异有统计学意义(P＜0.05).结论 骨髓水肿发现于股骨头缺血性坏死的Ⅱ、Ⅲ期,其发生与股骨头塌陷明显相关,多发生于症状出现后6个月内,其疼痛程度较同期无骨髓水肿的股骨头重.STIR成像能更敏感地发现骨髓水肿.

Objective To explore the mechanism of bone marrow edema(BME),the correlation between BME.collapse and pain in osteonecrosis of the femoral head.Methotis From January 2006 to Octobet 2007.165 hips in 91 cases with osteonecrosis of the femoral head were analyzed.Pain was recorded by using the method of Merle d'Aubigne as modified by Chamley.16 cases with BME were followed up by MRI regularly.Results BME were found in 47 hips among total 165 hips.According to ARCO staging,there were no BME occurred in stage Ⅰ(11 hips);13 hips BME occurred in stage Ⅱ(71 hips);34 hips BME occurred in stage Ⅲ(77 hips);no BME occurred in stage Ⅳ(6 hips).There was,significant difference between them(P＜0.05).37 hips with BME occurred on both 112WI and STIR.10 hips occurred only on STIR.40 hips with BME occurred in 6 months since the onset of pain,7 cases in 7-15 months.The pain was 2.46±0.66 in stage Ⅱ with BME,5.21±1.12 witbout BME,there Was signfficant difference between them.The pain Was 2.38±0.78 in stage Ⅲ with BME.3.63±0.93 without BME,there was significant difference between them.In 16 hips with BME followed-up with MRI,the pain Was alleviated when BME disappeared.Conclusion BME often 0ccal-8 in stage Ⅱ and Ⅲ osteonecrosis of the femoral head,and in 6 months since the onset of pain.The relation between BME and collapse is significant.The severity of pain with BME is more than that without BME.STIR is more sensitive in discovering BME.