多灶性骨坏死的发病规律

Occurrence regularity of multifocal osteonecrosis

[目的]通过分析本中心收治的多灶发性骨坏死(multifocd osleonecrosis,MFON)病例的发病率、发病原因、诊断及治疗,研究如何实现对MFON的早期诊断,避免漏诊,并寻求最佳治疗方案。[方法]在2010年1月~2015年6月对本中心收治的存在MFON高危因素的骨坏死患者行影像学筛查,筛查中髋、膝关节均呈阳性者,不论其他关节是否存在临床症状,均加摄双肩、双踝MRI,必要时加摄双腕和双肘关节;对有皮质类固醇使用史或酗酒史偶尔查出肩、踝、腕、肘一个至数个关节坏死的患者,加摄髋、膝关节MRI及行其他部位的影像学检查。通过筛查,明确MFON诊断。[结果]2010年1月~2015年6月,本中心共收治骨坏死患者1 507例,入院诊断MFON仅48例,占3.1%,对入院未诊断MFON但存在高危因素的102例患者行影像学筛查,增加诊断MFON 31例,该时间段收治骨坏死患者MFON诊断率上升为5.2%。[结论]对有高危因素的骨坏死患者,应警惕MFON的存在,必要时增加其他关节的影像学筛查,以期实现MFON的早诊断、早治疗。

[Objective] To evaluate the morbidity, pathology, diagnosis and treatment of multifocal osteonecrosis（MFON）in patients from our center to to facilitate earlier diagnosis and optimize treatment. [Methods] From January 2010 to June2015, the MRI screening of both shoulders and ankles was taken from the patients with osteonecrosis high risk factors. For patients with symptoms in other joints, especially the hip and knee, MRI was continuously performed on bilateral shoulders and ankles, and also bilateral wrists and elbows when necessary. If patients were found to have shoulder, ankle, wrist or elbow osteonecrosis, MRI was further performed on their hips and knees, and also other joints when necessary. [Results] A total of 1507 patients with osteonecrosis were admitted in our center, but only 48 were diagnozed as having MFON. In other 102 patients with high risk factors, more joints were screened with MRI, which brought more 31 confirmed MFON cases. Finally,the overall diagnostic confirm rate improved by 5.2% during this period, with statistically significant difference（P〈0.05）. [Conclusion] For patients with high-risk factors, MFON should be noticed. It is necessary to screen other joints to avoid miss-diagnosis. Early diagnosis and early treatment are significant to obtain the best clinical results.