髋部暂时性骨质疏松症的诊断与保守治疗  

Diagnosis and conservative treatment of transient osteoporosis of the hip

作　　者：孙大铭[1] 张洪[1] 

机构地区：[1]解放军总医院第一附属医院骨科,北京100048

出　　处：《中华骨科杂志》2010年第10期951-954,共4页Chinese Journal of Orthopaedics

摘　　要：目的探讨暂时性骨质疏松症的诊断方法及保守治疗疗效。方法回顾性分析2006年10月至2009年7月收治的10例暂时性骨质疏松症患者的临床资料，对其临床表现、体格检查及影像学特征进行归纳。男4例，女6例；年龄22-43岁，平均35岁。所有女性患者均不在妊娠期内。2例髋关节正侧位X线片表现正常，8例表现为股骨头不同程度的骨质疏松，骨小梁模糊：MRI均表现为广泛均匀的信号改变，累及股骨头和股骨颈，其中7例病变同时出现在股骨转子周围。T1加权像表现为低信号，T2加权像表现为高信号。治疗方法包括避免重体力劳动、过量运动、长距离行走及采用药物治疗，药物包括非甾体抗炎镇痛约和二膦酸盐类药物。采用四点口述分级疼痛评分和Harris髋关节评分对治疗结果进行评价。结果10例均获得随访，随访时间1．0-3．5年，平均2．5年。治疗1天后临床症状开始改善，治疗前疼痛评分为3级8例、4级2例，治疗6个月后为1级6例、2级3例、3级1例。治疗前Harris髋关节评分65-85分，平均74．5分；治疗6个月后84-100分，平均96分。治疗6个月后，X线片及MRI影像均基本恢复正常。结论暂时性骨质疏松症是一种一过性、自限性疾病，有独特的临床及影像学特征。保守和支持疗法对暂时性骨质疏松症有效。Objective To investigate clinical diagnosis and clinical outcome of conservative treatment for transient osteoporosis of the hip. Methods Between October 2006 and July 2009, 10 patients with transient osteoporosis of the hip were treated in out-patient clinic. The clinical and radiologic characteristics were studied retrospectively. There were 4 males and 6 females with an average age of 35 years （range, 22- 43）. All female patients were not in the period of pregnancy. The diagnosis was made based upon detailed X- ray and MRI evaluations. X-ray revealed osseous demineralization of the femoral head at 8 patients and showed normal at 2 patients. All patients showed the characteristic MRI pattern of transient osteoporosis of the hip. The involved hip had a diffuse and homogeneous area of low signal intensity on Trweighted images and high signal intensity on T2-weighted images in the head, neck and the intertrochanteric region in 7 patients. Non-operative management, consisting of symptomatic therapy and reduction of weight hearing was performed in all patients. Symptomatic therapy included nonsteroidal anti-inflammatory drug and bisphosphonate administration. Verbal pain rating scale and Harris hip score were used to assess the results of the treatment. Results All 10 patients have been followed up at 3, 6 and 12 months interval after they received treatments. The last follow-up duration of all 10 patients was 2.5 years （range, 1.0-3.5）. All patients had pain relief in varying degrees at 1 day after the therapy. The pain scale level had diminished in all patients, while the Harris hip score had increased from 74.5 pre-therapy to 96 post-therapy. X-ray and MRI showed complete recovery after 6 months. No complications were found among them. Conclusion Transient osteoporosis of the hip was considered to be a distinct, self-limiting, and transient disease, which had specific clinical and radiologic characters. Non-operative management should be the first choice to treat this disease.

关 键 词：骨质疏松 骨髓 水肿 髋关节 

分 类 号：R686[医药卫生—骨科学]