阿仑膦酸钠治疗髋部骨髓水肿综合征的病例分析

Case series of alendronate in treatment of bone marrow edema syndrome of the hip

目的探讨口服阿仑膦酸钠治疗髋部骨髓水肿综合征(bone marrow edema syndrome,BMES)的临床效果。方法回顾2017年12月—2020年1月口服阿仑膦酸钠治疗髋部BMES的8例患者(10个患髋)的临床资料,对比治疗前后Harris评分观察髋关节功能状态,连续MRI检查评估骨髓水肿变化情况,统计患髋临床治愈率以及启动治疗到临床治愈的时间,评估口服阿仑膦酸钠是否有助于缩短髋部BMES的病程。结果所有患者均获完整随访资料,平均随访(5.2±1.2)个月。8例患者(10个患髋)中共有7例(9个患髋)获得临床治愈,治愈率90%。启动治疗到临床治愈时间为1~2个月,平均(1.7±0.2)个月;髋关节Harris评分由治疗前平均(57.8±6.3)分提升到最后(98.6±1.0)分,差异有统计学意义(t=18.299,P<0.001)。1例患者(1个患髋)治疗1个月后发展为股骨头坏死,予以持续阿仑膦酸钠、钙剂和阿司匹林治疗,随访12个月复查MRI未见股骨头坏死面积扩大,股骨头未塌陷,髋关节残留轻微疼痛症状。结论髋部BMES并非完全是一种自限性疾病,部分患者有可能发展为股骨头坏死。口服阿仑膦酸钠能够有效治疗髋部BMES,改善临床症状,促进水肿消退,缩短疾病病程。

Objective To explore the clinical outcome of alendronate in the treatment of bone marrow edema syndrome of the hip.Methods A retrospective analysis of 8 cases(10 hips)of bone marrow edema syndrome of the hip treated with alendronate between December 2017 and January 2020 was conducted.Harris score and MRI exam of hip were used to assess the clinical and radiographical outcomes.Clinical cure rate and length of treatment period were used to evaluate whether alendronate was benefitial for the treatment of bone marrow edema syndrome of the hip.Results All the cases were followed up for at least 3 months and got complete clinical data,the mean follow-up period was(5.2±1.2)months.Seven cases(9 hips)in 8 cases(10 hips)had clinical cure,with a clinical cure rate of 90%.The length of treatment period was 1 to 2 months with a mean value of(1.7±0.2)months.The Harris score increased from 57.8±6.3 before treatment to 98.6±1.0 at the last follow-up,and the difference was statistically significant(t=18.299,P<0.001).One case(1 hip)developed osteonecrosis of femoral head at one month after the initiation of alendronate therapy,who received continuous combination therapy of alendronate,calcium and aspirin,and no collapse or expansion of necrosis was found after 12 months follow-up.Conclusions Bone marrow edema syndrome of the hip is not a self-limiting disease completely,some patients maybe develop osteonecrosis of femoral head.Alendronate is benefitial for alleviating clinical symptom,accelerating bone edema disappearance,and shortening the course of disease.