Clinical Research Of Osteonecrosos Of The Femoral Head

Clinical analysis of osteonecrosis of the femoral head with different etiologyObjectives:To explore the compositions and clinical characteristics of osteonecrosis of the femoral head (ONFH) with different etiology. Methods:From January 2000 to August 2008,602 cases (1036 hips) of ONFH were collected to analyze the compositions and clinical characteristics of different etiology. Results:In corticosteroid group, there are 280 cases (518 hips), male 160 cases, and female 120 cases; average 35.58±10.87 years old. The times from taking corticosteroid to the onset of pain were 25.95±34.94 months.37 cases have been misdiagnosed. The mean stage was 2.48±0.76 according to ARCO staging system. In alcoholic group, there are 194 cases (346 hips), male 193 cases, and female 1 case; average 41.55±9.09 years old. The times from taking alcohol to the onset of pain were 183.68±86.17 months.55 cases have been misdiagnosed. The mean stage was 2.69±0.67. In traumatic group, there are 52 cases (52 hips), male 25 cases, and female 27 cases; average 41.63±15.84 years old. The times since injury to the onset of pain were 24.13±27.85 months. No misdiagnosed. The mean stage was 2.90±0.77. In idiopathic group, there are 52 cases (77 hips), male 30 cases, and female 22 cases; average 40.87±14.24 years old.14 cases have been misdiagnosed. The mean stage was 2.55±0.77. In corticosteroid combined with alcohol group, there are 19 cases (36 hips), male 19 cases; average 40.42±11.64 years old.5 cases have been misdiagnosed. The mean stage was 2.61±0.63. Conclusions:Traumatic osteonecrosis of the femoral head have more advanced ARCO stage and lowest misdiagnosis when complained with discomfort. Corticosteroid drugs still is the main cause of ONFH, which affect younger person than other groups, with lower misdiagnosis. Most of alcoholic osteonecrosis of the femoral head occurred in male. The correlation between bone marrow edema, collapse and pain in osteonecrosis of the femoral head.Objective:To explore the mechanism of bone marrow edema(BME), the correlation between BME, collapse and pain in osteonecrosis of the femoral head. Methods: From January 2006 to October 2007,165 hips in 91 cases with osteonecrosis of the femoral head were analyzed. Pain was recorded by using the method of Merle d'Aubigne as modified by Charnley.16 cases with BME were followed up by MRI regularly. Result:47 hips revealed with BME,13 hips occurred in stage II classified by ARCO,34 cases in stage III.37 hips with BME occurred on both T2WI and STIR.10 hips occurred only on STIR.40 hips with BME occurred in 6 months since the onset of pain,7 cases in 7-15 months (p<0.05). The pain was 2.46±0.66 in stageⅡwith BME,5.21±1.12 without BME (p<0.05). The pain was 2.38±0.78 in stage III with BME,3.63±0.93 without BME (p<0.05). Conclusion:The relation between BME and collapse was significant. The majority of BME occurred in 6 months since the onset of pain. The severity of pain with BME is often 1 degree more than those without BME. STIR is more sensitive in discovering BME. Midterm follow-ups of SARS patients treated with corticosteroid with MR imagingObjective:To observe the differences and changes of MR images of normal adult femoral head and osteonecrosis of the femoral head in severe acute respiratory syndrome (SARS) patients treated with corticosteroid. Methods:From Jun 2003 to Jan 2004,539 SARS patients (1078 hips) treated with corticosteroid were examined by radiography and magnetic resonance imaging.130 cases (210 hips) developed osteonecrosis of the femoral head (ONFH),459 cases (868 hips) without ONFH. Patients with ONFH were followed up by MR imaging annually. From February to November in 2007,510 SARS patients (1020 hips) were examined by radiographs and magnetic resonance imaging again. All MRI examinations were performed with same protocol. The images of femoral head with or without necrosis were compared. Results:Necrotic lesions were detected on MRI in 6 months since the administration of corticosteroid. The signal types of ONFH can change after collapse or operation. Low signal intensity on T1 weighted image and high signal intensity on corresponding short time inversion recovery image (STIR) was still observed in all necrotic femoral head.3 necrotic femoral heads showed lesion size reduction on MRI. 4 types of MR image were observed in normal femoral head.24 hips with abnormal signal on T1 weighted image and normal signal on the corresponding STIR were diagnosed as normal. Conclusions:Necrotic lesions were detected on MRI in 6 months since the administration of corticosteroid. There is signal variability in normal femoral head. Low signal intensity on T1 weighted image and high signal intensity on corresponding STIR can be used as diagnostic standards of ONFH. Only little necrotic femoral heads showed lesion size reduction on MRI.