CAJ | 학술논문

目的：分析非症状性骨坏死未经手术治疗的早期病情转归及病灶大小、位置与病情进展的关系。方法自2008年1月至2009年6月，大连大学附属中山医院骨科收治的股骨头坏死患者病例中选取24例髋纳入本研究，男16例，女8例，年龄平均36.4（22～46）岁，体质指数平均25.4（17.5～35.0）。按照ARCO分期标准分为，Ⅰa期2髋，Ⅰb期4髋，Ⅱa期6髋，Ⅱb期8髋，Ⅱc期4髋。病因为激素性16例，酒精性4例，特发性4例。影像学评估按照MRI下骨坏死指数法评价坏死范围，按照股骨头内侧区，中央区，外侧区评价骨坏死位置。结果随访平均43.8（32～60）个月，至末次随访，评估侧有7髋（29.2％）出现疼痛症状，出现时间为首次检出后平均42.4（36～50）个月，包括激素性5髋，酒精性2髋，7髋分期均发生进展，5髋进展至股骨头塌陷，时间为首次检出后平均40（36～48）个月，病灶位于外侧-中央区4髋，同时累计内外侧及中央区3髋。病变进展为症状髋的骨坏死指数平均为45.4％，无症状髋平均为32.7％，差异有统计学意义。结论当病灶位于股骨头外侧区域或同时累计内外侧中心区域，则病变进展的可能性加大，应考虑手术治疗干预；当病变范围较小，病变局限于中心区或内侧区，可在监测病情变化的同时行保守治疗。
목적：분석비증상성골배사미경수술치료적조기병정전귀급병조대소、위치여병정진전적관계。방법자2008년1월지2009년6월，대련대학부속중산의원골과수치적고골두배사환자병례중선취24례관납입본연구，남16례，녀8례，년령평균36.4（22～46）세，체질지수평균25.4（17.5～35.0）。안조ARCO분기표준분위，Ⅰa기2관，Ⅰb기4관，Ⅱa기6관，Ⅱb기8관，Ⅱc기4관。병인위격소성16례，주정성4례，특발성4례。영상학평고안조MRI하골배사지수법평개배사범위，안조고골두내측구，중앙구，외측구평개골배사위치。결과수방평균43.8（32～60）개월，지말차수방，평고측유7관（29.2％）출현동통증상，출현시간위수차검출후평균42.4（36～50）개월，포괄격소성5관，주정성2관，7관분기균발생진전，5관진전지고골두탑함，시간위수차검출후평균40（36～48）개월，병조위우외측-중앙구4관，동시루계내외측급중앙구3관。병변진전위증상관적골배사지수평균위45.4％，무증상관평균위32.7％，차이유통계학의의。결론당병조위우고골두외측구역혹동시루계내외측중심구역，칙병변진전적가능성가대，응고필수술치료간예；당병변범위교소，병변국한우중심구혹내측구，가재감측병정변화적동시행보수치료。
Objective To analyze the progression of asymptomatic osteonecrosis of the femoral head by evaluating its lesion size and location.Methods From January 2008 to June 2009, 24 cases or hips were available for outcome analysis.There were 16 males and 8 females with a mean age of 36.4 (22-46) years and a mean body mass index of 25.4 ( 17.5-35 ).The stages were Ⅰa ( n=2 ) , b ( n=4 ) , Ⅱa (n=6), Ⅱb (n =8) and Ⅱc (n =4) according to ARCO staging system.The etiologies included corticosteroids ( n=16 ) , alcohol abuse ( n =4 ) and idiopathic disease ( n =4 ).Magnetic resonance imaging ( MRI) was used to measure lesion sizes with necrotic index method.And lesion locations were classified as medial , central and lateral.Results The mean follow-up period was 40.3 (32-60) months.Among 7 painful hips, there were corticosteroids (n=5) and alcohol abuse (n=2).And 5 hips (20.8%) collapsed.The mean interval between diagnosis and symptom was 40 (36-48) months.The lesion locations were lateral-central ( n =4 ) lateral-central-medial ( n =3 ).Significant difference existed between the average necrotic index of symptomatic and asymptomatic hips (45.4%vs 32.7%).Conclusion There is a high risk of progression into symptomatic disease when the necrotic lesion occurs on the lateral and lateral -central or lateral-central-medial zone of the femoral head.Asymptomatic small and medially located lesions may be managed conservatively with close medical imaging observations.