股骨头坏死骨髓水肿的临床分析

Clinical evaluation of bone marrow edema in osteonecrosis of femoral head

[目的]探讨股骨头坏死骨髓水肿(bone marrow edema,BME)与临床症状和影像学改变的相关性。[方法]40例(70髋)股骨头坏死患者,通过MRI脂肪压抑图像确认BME,并对其分级:0级25髋(无BME),1级20髋(BME弥散在股骨头),2级14髋(BME弥散在股骨头、颈);3级11髋(BME弥散在股骨头、颈以及股骨近端)。分析BME与年龄,病因、ARCO分期、疼痛分组、坏死范围以及股骨头塌陷之间的相关性;运用多个独立样本非参数检验和列联表X2检验。[结果]BME与年龄、病因无相关性;各分期中BME分级的差异有显著意义(X2=21.1,P=0.0 003),各分期的BME发生有显著差异(X2=28.51,P<0.0 001);不同坏死范围中,BME分级有显著差异(X2=9.77,P=0.021),但BME的发生无显著差异(X2=6.227,P=0.101);股骨头塌陷与BME分级无相关性(X2=2.558,P=0.465),但BME的发生与股骨头塌陷有相关性(X2=22.799,P<0.001);不同疼痛程度中BME分级有显著性差异(X2=26.66,P<0.001),BME的发生与疼痛程度有相关性(X2=40.855,P<0.001)。[结论]BME的发生与年龄、病因无相关性;BME弥散程度与坏死范围、疼痛程度、股骨头塌陷存在相关性,BME的发生与坏死范围无关,与疼痛、塌陷密切相关;BME可能是由股骨头塌陷所导致的病理改变。

[Objective] To evaluate the relationship between the clinical symptoms , imageology changes and the bone marrow edema （BME） in osteonecrosis of femoral head （ONF） on magnetic resonance images （MRI） . [ Method] The subjects were 40 patients with 70 hips showing ONF. BEM was diagnosed according fat suppression images of MRI, associated focal and diffuse BME were graded as grade 0 with 25 hips （ no BME）, grade 1 with 25 hips （ BME diffuse to the femoral head）, grade 2 with 14 hips （BME diffuse to the femoral head and neck）, grade 3 with 11 hips （BME diffuse to the femoral head and neck, proximal femur） . Correlation of BME was evaluated to age, etiological factor, stages of ONF, pain grade, the extent of ONF and to collapse of the femoral head. [ Result] There was no correlation of BME to age and to etiological factor. The grades of BME correlated significantly with the stages of ONF （X^2 = 21.1, P =0. 0 003 ） . The presence of BME correlated significant- ly with the stages of ONF （X^2 =28.51, P 〈0. 0 001 ） . The grades of BME correlated significantly with the extent of ONF （X^2 =9. 77, P = 0. 021 ）, but there was no correlation of the presence of BME to the extent of ONF （X^2 = 6. 227, P = 0. 101 ） . There was no correlation of the grades of BME to collapse of the femoral head （ X^2 = 2. 558, P = 0. 465 ）, but the presence of BME correlated significantly with the collapse （ X^2 = 22. 799, P 〈 0. 001 ） . In each the groups of pain, the grades of BME was of great significant difference （ X^2 = 26. 66, P 〈 0. 001 ） , the presence of BME was of great significant difference （X^2= 40. 855, P 〈0. 001 ） . [ Conclusion] The presence of BME does not correlate significantly with ages of patients or etiological factor. The extent of BME significantly correlated with the extent of ONF, the worsening of hip pain, and collapse of the femoral head. The presence of BME does not correlate significantly to the extent of necrosis, and correlate significantly to the hip pain, collapse of the femoral head. Collapse of the femoral head seems to result in the appearance of the BME pathophysiology.