目前国内外尚缺乏专题探讨骨髓水肿的产生及发展对于骨坏死治疗的指导意义对于骨髓水肿发生后股骨头内的微观改变亦缺乏统一认识。笔者基于临床经验认为对于髋关节疼痛较重并且伴有中、重度骨髓水肿的 ARCO Ⅱ期骨坏死患者应当高度关注不能因为此时 X 线片未显示塌陷而在治疗上放松警惕。此期 X 线片显示的未塌陷可能为“假阴性”因为 X 线片反映的仅仅是冠状位骨质投影的叠加影像其对股骨头内微观骨质改变分辨较差。笔者推测对于伴有中、重度骨髓水肿的Ⅱ期坏死头内可能已经由于不稳定而产生各式各样的微骨折或断裂带股骨头塌陷的风险性较高甚或已经发生塌陷此时单纯非手术治疗恐难以胜任需要及早进行外科干预如早期减压植骨、重建力学稳定等对于预防或纠正塌陷、延缓病情发展至关重要。 目前国内对于骨髓水肿的研究尚处于起步阶段还有许多问题需要研究、论证。譬如如何通过量化骨髓水肿的程度来具体预测或评估塌陷中、重度水肿是否可以做为早期股骨头坏死的一个重要手术指征骨髓水肿与坏死预后的关系如何等等这些问题尚需要进一步的观察研究。 【参考文献】 Bloem JL.Transient osteoporosis of the hipMR imaging[J].Radiology1988167(3) Potter HMoran MSchneider Ret al.Magnetic resonance imaging in diagnosis of transient osteoporosis of the hip[J].Clin Orthop Relat Res1992(280) Dunstan CREvans RASomers NM.Bone death in transient regional osteoporosis[J].Bone199213(2) Fujioka MKubo TNakamura Fet al.Initial changes of nontraumatic osteonecrosis of femoral head in fat suppression imagesbone marrow edema was not found before the appearance of band patterns[J].Magn Reson Imaging200119(7) Lida SHarada YShimizu Ket al.Correlation between bone marrow edema and collapse of the femoral head in 2000174(3) Koo KHAhn IOKim Ret al.Bone marrow edema and associated pain in early stage osteonecrosis of the femoral headProspective study with serial MR images[J].Radiology1999213(3) Kubo TYamamoto TInoue Set al.Histological findings of bone marrow edema pattern on MRI in osteonecrosis of the femoral head[J].Orthop Sci20005(5) [8]Akisue TMatsumumoto KFujita Iet al.Bone marrow edema syndrome associated with uterine myomaa case report[J].Clin Orthop Relat Res2003(409) [9]Kim YHKim JS.Histologic analysis of acetabular and proximal femoral bone in patients with osteonecrosis of the femoral head[J].J Bone Joint Surg(Am)200486(11)2471. [10]Jones JP.Ostonecrosis[M]∥McCarty DJKoopmann WJ.Arthritis and allied conditionsa textbook of rheumatology 12th ed.PhliadelphiaPa Lea & Febiger1993 [11]储玉山曹建民孔伟东等.非创伤性股骨头缺血性坏死骨髓水肿的数字减影血管造影研究[J].医学研究生学报200619(9) [12]Schweitzer MEWhite LM.Does altered biomechanics cause marrow edema?[J].Radiology1996198(3) [13]Kim YMOh HCKim HJ.The pattern of bone marrow oedema on MRI in osteonecrosis of the femoral head[J].J Bone Joint Surg(Am)200082(4) [14]Yao LLee JK.Occult intraosseous fracturedetection with MR imaging[J].Radiology1988167(3) [15]Li KCHiette P.Contmagnetic resonance imaging for studying the pathophysiology of osteonecrosis of the hips[J].Skeletal Radiol199221(4) [16]何伟曾勤张庆文等.非创伤性股骨头坏死骨髓水肿与疼痛分级及坏死分期相关性的研究[J].中国修复重建外科杂志200822(3) [17]Castro JRBarrack RL.Core decompression and conservative treatment for avascular necrosis of the femoral heada orthopedics200029 [18]Stafford SARosenthal DIGerbhardt MCet al.MRI in stress fracture[J].AJR Am J Roentgend1986147(2) [19]刘少军王海彬唐立明等.股骨头坏死骨髓水肿的临床分析[J].中国矫形外科杂志200816(13) [20]赵培荣庄奇新乔瑞华等.股骨头缺血坏死骨髓水肿的 MRI 研究[J].实用放射学杂志200622(7) [21]Curtiss PHKincaid WE.Transitory demineralization of the hip in pregnancya report of three cases[J].J Bone Joint Surg(Am)195941 [22]Wilson AJMurphy WAHardy DCet al.Transient osteoporosistransient bone marrow edema?[J].Radiology1988167(3) [23]Guerra JJSteinberg ME.Distinguishing transient osteoporosis from avascular necrosis of the hip[J].J Bone Joint Surg(Am)199577(4) [24]Lequesne M.Transient osteoporosis of the hipa nontraumatic variety of Sudeck′s atrophy[J].Ann Rheumat Dis196827(3) [25]Negri GGrassi SZappia Set al.A new hypothesis for the bone marrow edema pathogenesis during transient osteoporosis[J].J Orthopaed Traumatol20067(2) [26]Lieberman JRBerry DJMont MAet al.Osteonecrosis of the hipJoint Surg(Am)200284(4) [27]Yamamoto TKubo THirasawa Yet al.A clinicopathologic study of transient osteoporosis of the hip[J].Skeletal Radiol199928(8)621. [28]Berger CEKroner AH et al.Biochemical markers of bone metabolism in bone marrow edema syndrome of the hip[J].Bone200333(9)346. [29]Sherry AGuardiano DOJames Ket al.Fracture complicating the bone marrow edema syndrome[J].J Clin Rheumatol200410(5) [30]Calvo Edecompression shortens the duration of pain in bone marrow oedema syndrome[J].International Orthopaedics200024(1) [31]Krausel RGlasl KSchulz Aet al.The transitory bone marrow edema syndrome of the hip[J].Z Orthop Unfall2002140(3)