早中期股骨头坏死疼痛与坏死面积及关节积液分级相关性分析

The Correlation between Pain and Necrotic Area and Joint Effusion of Osteonecrosis of the Femoral Head in Early and Medium-Term

目的探讨早中期股骨头坏死疼痛与坏死面积及关节积液分级的相关性。方法 76例（116髋）患者进行研究。其中男47例,女29例;平均年龄39岁（21~62岁）;左侧55髋,右侧61髋。其中Ⅰ期5髋,Ⅱ期44髋,Ⅲ期67髋。所有患者均行标准正位和蛙式位X线片、轴位CT扫描及冠状位、矢状面重建等检查,所有患者均接受MRI检查判断早期坏死范围及关节积液等级。根据MRI、CT及X线片表现确定ARCO分期,参考Liu等关节积液分级作为关节积液量评判标准,以语言模拟评分法（verbal rating scale,VRS）作为描述性疼痛的程度分级法,以Kruskal-Wallis秩和检验作为检验方法。结果随着股骨头坏死的进展,疼痛也逐渐加重;Ⅱ期和Ⅲ期中坏死范围越大,疼痛症状加重;关节积液分级与疼痛呈正相关。结论早中期股骨头坏死疼痛与坏死范围及关节积液均有密切联系,坏死范围大,积液多则疼痛重。

Objective To study the correlation between necrosis area,joint effusion and pain in early and medium-term osteonecrosis of the femoral head. Methods 76 cases（116 hips）with osteonecrosis of the femoral head were studied. There were 47 male and 25 female with a mean age of 39 years old（21 ~ 62 y ）. And there were 55 case of left hip,cases of the right hip. There 5 hips in stage Ⅰ,44 hips in stage Ⅱ,67 hips in stage Ⅲ according to ARCO. All cases underwent standard antero-posterior and frog-leg X -ray;axial CT scans and coronal,sagittal reconstruction. All cases underwent MRI examination to esti-mate the necrotic area and the effusion grade. The ARCO stage were judged according to the findings of MR,CT and X -rayg. The joint effusion estimated according to the methods of Liu. The degree of pain was judged using the methods of VRS（Verbal rating scale）. The Kruskal-Wallis rank-sum test was used. Results The pain gradually worsened with the progress of the fem-oral head necrosis,The pain symptoms were worse with the necrotic area greater in stage Ⅱ and stage Ⅲ. The joint effusion and pain were positively correlated. Conclusion The correlation exist between the pain symptoms of osteonecrosis of the femo-ral head and the necrotic area and joint effusion. The pain symptoms were worse with the necrotic area and fluid volume increa-ses.