早期预测股骨头坏死累及髋臼软骨的临床意义

Clinical significance of predicting acetabular cartilage-involved osteonecrosis of the formal head

目的研究早期股骨头坏死(NFH)累及髋臼软骨的可能预测指标,为股骨头表面置换术(SRHA)治疗年轻NFH提供依据。方法13例15髋NFH均符合THA手术指征而接受了THA治疗。术中对每例患者的髋臼软骨进行大体观察,然后取材供组织学检查,并将结果与术前疼痛时间和NFH的ARCO分期、股骨头塌陷程度进行相关性分析。结果术前疼痛时间在平均7.4个月组的7髋中,ARCO分期为ⅡC和ⅢA期,髋臼软骨的大体和组织病理均呈Ⅰ级轻度损伤者5髋,仅Ⅰ级组织病理损伤者2髋。而术前疼痛时间在平均16.5个月的8髋中,ARCO分期为ⅡB和ⅢC期,大体和组织病理显示Ⅱ级中度损伤者6髋,Ⅲ级重度损伤者2髋。多元回归分析显示病理学评分与疼痛持续时间及塌陷程度呈密切相关。结论NFH患者的髋臼软骨损伤远早于影像学改变。ARCO分期为ⅡC和ⅢA期,疼痛时间<1年者,应是SRHA的最佳手术指征。

Objective To find the signs predicting degeneration of acetabular cartilage in early stage of necrosis of the femoral head（NFH）, and provide with a recommendation of the surface replacement hemiarthroplasty（SRHA） in young adults with osteonecrosis of the femoral head. Methods 13 patients（15 hips）（6 men and 7 women, 19-74years old）were included in this study,and all had the indications for THA. Biopsy specimens of cartilage and adjacent subchondral bone were obtained from the weight-bearing dome of the acetabulum of 15 hips during total hip replacement. The cartilage was evaluated grossly and histologically. The correlation between deterioration of acetabular cartilage and the degree of collapse of femoral head and the duration of pain of the hip were analyzed. Results Seven hips with mean pain duration of 7.4 months before operation were assigned to stageⅡ-C and Ⅲ-A with mild degeneration on histological and gross examination in 5 hips and mild denegation on histological examination in 2 hips. Eight hips with mean pain duration of 16.5 months before operation were assigned to stage Ⅱ-B and Ⅲ-C with moderate degeneration in 6 hips and severe degeneration on histological and gross examination in 2 hips. The amount of deterioration of acetabular cartilage was directly proportional to the degree of collapse of the femoral head and the duration of pain of the hip.Conclusion Degenerative changes of acetabulum cartilage are present earlier than the changes on radiographs of the acetabulum. SRHA may be most suitable for the patients with pain duration less than one year and with stage of Ⅱ-C and Ⅲ-A（ARCO）.