非创伤性股骨头坏死骨髓水肿与疼痛分级及坏死分期相关性的研究

STUDY ON CORRELATION BETWEEN PAIN GRADING, STAGE OF NECROSIS AND BONE MARROW EDEMA IN NONTRAUMATIC OSTEONECROSIS OF FEMORAL HEAD

目的探讨非创伤性股骨头坏死(nontraumatic osteonecrosis of femoral head,NONFH)骨髓水肿与疼痛分级、坏死分期的相关性,提高对骨髓水肿在NONFH中临床意义的认识。方法 2004年10月-2006年10月收治的97例149髋NONFH患者进行回顾性分析。男68例,女29例;年龄19～62岁,平均38.8岁。病程20 d～4年。患者骨髓水肿根据MRI表现分为0～2级;疼痛分级按主诉疼痛分级法分为无疼痛(0级)、轻度疼痛(1级)和中重度疼痛(2级);坏死根据世界骨循环研究学会国际骨坏死分期标准分为Ⅰ～Ⅳ期。分析各级疼痛及各期骨髓水肿的发生率,并将骨髓水肿分别与疼痛分级、坏死分期进行列联表资料χ2检验及多个独立样本比较的秩和检验。结果 149髋中109髋发生骨髓水肿,发生率为73.15%。疼痛128髋中108髋(84.38%)存在骨髓水肿,其中2级疼痛34髋中,32髋(94.12%)存在骨髓水肿。疼痛分级与骨髓水肿分级有关(P < 0.001)。各级疼痛间的骨髓水肿差异有统计学意义(P< 0.001),随疼痛程度的加重骨髓水肿分级的平均秩次逐渐加大,0级、1级和2级分别为28.19、78.94和96.12。以坏死Ⅱ期(77.05%)、Ⅲ期(82.81%)患者骨髓水肿最多见且明显。坏死Ⅰ～Ⅲ期与骨髓水肿分级有关(P< 0.001)。Ⅰ～Ⅲ期坏死间骨髓水肿分级比较差异有统计学意义(P < 0.001),且随病变程度的加重,骨髓水肿分级的平均秩次逐渐加大,0级、1级和2级分别为39.07、60.16和86.15。结论骨髓水肿是NONFH发展过程中的一种伴随征象,骨髓水肿发生的几率和程度与NONFH疼痛分级、坏死分期密切相关,骨髓水肿的情况可作为评价病情进展及疗效判定的指标。

Objective To explore the correlation between pain grading, stage of necrosis and bone marrow edema （BME） in nontraumatic osteonecrosis of femoral head （NONFH） so as to strengthen understandings about clinical significance of BME in NONFH. Methods From October 2004 to October 2006, 97 patients （149 hips） with NONFH were treated. There were 68 males and 29 femals with an average age of 38.8 years （19-62 years）. The disease course was from 20 days to 4 years. BME was identified grade 0 to grade 2 according to MRI. Based on grading scale of pain, pain grading were divided into no pain （grade 0）, mild pain （grade 1） and moderate or severe pain （grade 2）. According to Association Research Circulation Osseous staging system, NONFH were divided into Ⅰ-Ⅳ stages. The incidence rate of BME in each pain grading and stages of necrosis was analyzed respectively. Contingency table analyses and rank sum tests were used to compare the difference of pain grading and stages of necrosis among these groups. Results The total incidence rate of BME was 73.15% （109/149）, the incidence rates were 84.38% in pain groups （108/128） and 94.12% in the grade 2 （32/34）. Pain grading correlated with BME rating （P 〈 0.001）. The results of rank sum tests for several independent samples showed significant difference in BME among pain groups（P 〈 0.001）. With the advance of pain scale, the mean rank of BME increased gradually（28.19 for grade 0, 78.94 for grade 1 and 96.12 for grade 2）. BME was more commonly and dearly seen in stage Ⅱ （77.05%） and stage Ⅲ（82.81%） of NONFH. Stage Ⅰ-Ⅲ of NONFH correlated with BME rating （P 〈 0.001）. The results of rank sum tests showed significant difference in BME rating among three stages （P 〈 0.001）. With the advance of disease, the rank of BME rating increased gradually （39.07 for grade 0, 60.16 for grade 1 and 86.15 for grade 2 ）. Conclusion BME is a sign that is accompanied with NONFH. The probability and extent of BME correlated well with the pain and stage of NONFH. The condition of BME can be used as a index for the appraisal of advancement of disease and the judgment of treatment result.