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[10]Jones JP.()stonecrosis[M]∥McCarty DJ,Koopmann WJ.Arthritis and rheumatology 12th allied conditions:a textbook of ed.Phliadelphia:Pa 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、延缓病情发展至关蕈要。 .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: [1 J Bloem JI。.Transient osteoporosis of the I.ea& Febiger。1993:1677—1695. [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):712—715. [12]Schweitzer ME。White LM.Does ics cause altered biomechan— marrow edema?[J].Radiology,1 996,l 98 (3):851-853. [13]Kim YM,Oh row HC,Kim on HJ.The pattern of bone mar— oedema MRI in osteonecrosis of the femoral Joint Surg(Am),2000,82(4):837— 。 head[J].J 841. Bone [1 4]Yao L,Lee JK.Occult intraosseous fracture:detec— tion with 749—751. 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