髋关节骨髓水肿与股骨头坏死的相关性研究

A study on the correlation between bone marrow edema of the hip and osteonecrosis of the femoral head

[目的]探讨髋关节骨髓水肿(bone marrow edema,BME)严重程度与股骨头坏死(osteonecrosis of the femoral head,ONFH)塌陷及Harris评分的相关性,为临床对股骨头坏死病情的了解和预后的判断起到指导作用。[方法]根据患者X线和MRI检查,58例(94髋)ONFH未伴有股骨头塌陷的患者,随访16～28个月,平均18个月,回顾性研究其BME严重程度与随访后股骨头塌陷与否以及Harris评分的相关性。[结果]骨髓水肿程度与塌陷相关性结果:Ⅰ级水肿塌陷率为4.5%,Ⅱ级水肿塌陷率为11.8%,Ⅲ级水肿塌陷率为66.7%,Ⅳ级水肿塌陷率为90%:骨髓水肿程度与Harris评分相关性结果:Ⅰ级水肿评分为93.0±5.41分,Ⅱ级水肿评分为84.1±5.42分,III级水肿评分为76.4±4.22分,Ⅳ级水肿评分为66.3±7.46分。[结论](1)骨髓水肿是ONFH一种继发征象;(2)通过骨髓水肿可以预测股骨头塌陷的趋势;(3)骨髓水肿分级与Harris评分呈负相关关系,即骨髓水肿范围越人,Harris评分越低。

[ Objective] To study the correlation between the severity of bone marrow edema （BME） and the collapse of osteonecrosis of the femoral head （ONFH） , to explore the relationship between the severity and the score of Harris, so as to offer the direction for understanding and judging the prognosis of ONFH clinically. [ Method ] Fifty - eight cases of ONFH patients （94 hips） without collapse, according to the X -Ray and the MRI examination, made a follow- up visit for 16 -28 months, an average of 18 months, and made a retrospective study of the correlation between the severity of BME and the collapse, the Harris of ONFH. [ Result] The correlation between the BME degree and the collapse of ONFH： the collapse rate was 4. 5% in degree Ⅰ , 11.8% in degree Ⅱ 66. 7% indegreeⅢ, 90% in degree Ⅳ. The correlation between the BME degree and the Harris： 93.0 ±5.41 in degree Ⅰ , 84. 1 ±5.42 in degree Ⅱ , 76. 4 ±4. 22 in degreeⅢ, 66. 3 ±7.46 in degree Ⅳ. [ Conclusion ] （ 1 ） BME is the secondary sign of ONFH ; （2） The tendency of collapse could be predicted through the BME ; （3） There is a negative correlation between the BME degree and the Harris, namely the larger scope of BME is, the lower the score of Harris is.