【作者】 何伟； 张庆文； 李勇； 王海彬； 方斌； 庞智晖； 袁浩；

【机构】 广州中医药大学第一附属医院关节专科、全国中医髋关节病重点专科；

【摘要】 目的:总结不明原因股骨头骨髓水肿的临床表现和疗效,进一步探讨股骨头骨髓水肿的诊疗规律。方法:回顾2007年6月至2008年3月的11例不明原因股骨头骨髓水肿病例。2例行髓芯减压术,余9例行休息和活血止痛为主的中药治疗。对其一般资料,初诊和复诊的临床表现、X片表现、MRI表现,病程时间,共五方面资料进行分析。结果:所纳入11例患者中:1)男8例、女3例;平均年龄44.81±7.14岁;右侧5例,左侧6例。2)初诊时临床表现以疼痛为主,髋关节功能良好。3)MRI上异常信号都为股骨侧,髋臼侧无明显信号异常。有3例为局限型;余8例为弥漫型。除2例外均伴有明显关节积液。4)有5例X片上伴有股骨头颈部区域局部的密度降低。5)以疼痛完全消失需要的时间计算疗程,本组平均为4.18±2.48月,MRI和X片亦同时恢复正常。随访至疼痛消失后3个月以上,症状无复发。结论:对于不明原因的股骨头骨髓水肿病例,在排除其他疾病后要考虑为骨髓水肿综合征或软骨下不完全骨折,尤其要与股骨头坏死相鉴别。MRI检查是诊断此类疾病的重要方法。一般给予休息和活血止痛中药治疗处理即可得到满意的疗效,仅疼痛明显者需要短时间给予非甾体消炎止痛药;而行髓芯减压术有可能会缩短病程。更多还原

【Abstract】 Objective This study was to find the rule of diagnosis and treatment on bone marrow edema(BME) of the femoral head.Methods 11 entered cases during JUN, 2007 to MAR,2008 were followed up.The related information was recorded and analyzed, such as epidemiology data,clinical presentation,disease course,radiographs and MRI.Results 1) there were eight male cases and three female;the average age was 44.81±7.14 years old;five hips in the right and six in the left.2) pain was the main symptom,which was totally released in the last follow-up;the average course of disease was 4.18±2.48 months.3) All abnormal signals on MRI were in the femoral side,acetabulum was not involved.Three cases had regional lesion and eight cases had diffuse one.All cases accompanied with joint effusion except two.4) The density decreased in five radiographs.All MRI and radiographs in the last follow-up return normal.There had not been recurrence for at least three months since pain disappeared.Conclusions For BME of the femoral head with unknown causes,the diagnosis of BME syndrome(BMES) or subcondral stress fracture should be considered and osteonecrosis of the femoral head should be differentiated.MRI is very useful in diagnosis.Generally,rest and symptomatic treatment was enough.Treatment with NSAID was helpful for releasing severe pain.The core decompression would probably shorten the disease course.更多还原