健脾活骨方治疗早中期非创伤性股骨头坏死的前瞻性临床研究

目的观察健脾活骨方治疗早中期非创伤性股骨头坏死的有效性及其特色,为早中期股骨头坏死的治疗提供一种可行、有效的方法。方法采用前瞻、配对、对照试验设计方案,将在中国中医科学院望京医院经健脾活骨方治疗的患者作为治疗组,经病灶清除打压植骨术治疗的患者作为对照组。将纳入患者按照ARCO分期相同、坏死面积相近、Harris评分相似、发病原因一致、人院治疗时间相近、体重指数相近、年龄相近的七个配对条件进行1：1配对,共配对120对（240例）。以X线影像稳定率、Harris评分、SF-36评分作为疗效评价指标,配对后进行12个月的随访,分析统计随访结果。结果治疗组影像稳定率为76．28％,与对照组的73．92％结果相当（x^2=0．173,P〉0．05）,治疗组Harris评分为87．67分,高于对照组的83．39分（t=2．658,P〈0．05）,SF-36评分中,生理功能、生理职能、躯体疼痛、总体健康、社会功能、情感职能分值高于对照组（t=4．28,P〈0．01;t=3．675,P〈0．01;t=4．28,P〈0．01;t=2．62,P〈0．05;t=4．92,P〈0．01;t=3．17,P〈0．05）,而活力分值低于对照组（t=2．339,P〈0．05）。不同分期研究显示,治疗组Ⅱ期患者影像稳定率82．02％略高于对照组的78．16％（x^2=0．412,P〉0．05）,而Ⅲ期55．17％的稳定率则略低于对照组的60．71％（x^2=0．179,P〉0．05）;Harris评分方面,两组两期疼痛缓解作用相近,其他方面则治疗组占优;SF-36评分中,治疗组Ⅱ期患者有略好于对照组趋势,而Ⅲ期则区别不明显。治疗组自身对照结果中,Ⅱ期患者影像稳定率为82．02％,高于Ⅲ期的55．17％（x^2=8．507,P〈0．01）,而Ⅱ期患者Harris评分优良率及SF-36总体健康分均低于Ⅲ期。结论健脾活骨方治疗早中期非创伤性股骨头坏死疗效肯定,在改善髋关节功能及提高生活质量方面略优于手术治疗。健脾法在早期比中期更显示出疗效优势,即使中期在影像效果不佳的情况下,中药治疗对缓解症状、改善功能、提高生活质量仍有积极的意义。     

结直肠癌淋巴结转移的规律及其影响因素

目的探讨结直肠癌淋巴结转移的规律及其影响因素。方法总结1166例接受手术治疗的结直肠癌患者的临床病理资料，分析各临床病理因素对结直肠癌淋巴结转移的影响。结果全组病例淋巴结转移率为49．7％；单因素分析显示，患者的性别（x^2=1．46，r=0．035，P〉0．05）和肿瘤部位（x^2=3．86，r=0．012，P〉0．05）与淋巴结转移无关；而年龄（x^2=13．1，r=0．064，P〈0．05）、肿瘤大小（x^2=77．161，r=0．245，P〈0．01）、大体类型（x^2=144．831，r=0．341，P〈0．01）、组织学类型（x^2=128．310，r=0．318，P〈0．01）、分化程度（x^2=120．418，r=0．319，P〈0．01）及浸润深度（x^2=227．287，r=0．434，P〈0．01）与淋巴结转移密切相关。Logistic多因素回归分析得出的与淋巴结转移的相关因素按密切程度依次递减为：浸润深度、大体类型、分化程度、肿瘤大小。术前血清癌胚抗原水平与淋巴结转移高度相关（x^2=509．599，r=0．661，P〈0．01）。结论结直肠癌的浸润深度是淋巴结转移发生的最主要因素；术前血清CEA水平的上升提示淋巴结转移的发生。     

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

目的探讨非创伤性股骨头坏死（nontraurnatic ostconecrosis of femoral head，NONFH）骨髓水肿与疼痛分级、坏死分期的相关性，提高对骨髓水肿在NONFH中临床意义的认识。方法2004年10月-2006年10月收治的97例149髋NONFH患者进行回顾性分析。男68例，女29例；年龄19～62岁，平均38．8岁。病程20d～4年。患者骨髓水肿根据MRI表现分为0～2级；疼痛分级按主诉疼痛分级法分为无疼痛（0级）、轻度疼痛（1级）和中重度疼痛（2级）；坏死根据世界骨循环研究学会国际骨坏死分期标准分为Ⅰ～Ⅳ期。分析各级疼痛及各期骨髓水肿的发生率，并将骨髓水肿分别与疼痛分级、坏死分期进行列联表资料x^2检验及多个独立样本比较的秩和检验。结果149髋中109髋发生骨髓水肿，发生率为73．15％。疼痛128髋中108髋（84．38％）存在骨髓水肿，其中2级疼痛34髋中，32髋（94．12％）存在骨髓水肿。疼痛分级与骨髓水肿分级有关（P〈0．001）。各级疼痛间的骨髓水肿差异有统计学意义（P〈0．001），随疼痛程度的加重骨髓水肿分级的平均秩次逐渐加大，0级、1级和2级分别为28．19、78．94和96．12。以坏死Ⅱ期（77．05％）、Ⅲ期（82．81％）患者骨髓水肿最多见且明显。坏死Ⅰ～Ⅲ期与骨髓水肿分级有关（P〈0．001）。Ⅰ～Ⅲ期坏死间骨髓水肿分级比较差异有统计学意义（P〈0．001），且随病变程度的加重，骨髓水肿分级的平均秩次逐渐加大，0级、1级和2级分别为39．07、60．16和86．15。结论骨髓水肿是NONFH发展过程中的一种伴随征象，骨髓水肿发生的几率和程度与NONFH疼痛分级、坏死分期密切相关，骨髓水肿的情况可作为评价病情进展及疗效判定的指标。     

股骨头坏死骨髓水肿的临床分析

[目的]探讨股骨头坏死骨髓水肿（bone marrow edema，BME）与临床症状和影像学改变的相关性。[方法]40例（70髋）股骨头坏死患者，通过MRI脂肪压抑图像确认BME，并对其分级：0级25髋（无BME），1级20髋（BME弥散在股骨头），2级14髋（BME弥散在股骨头、颈）；3级11髋（BME弥散在股骨头、颈以及股骨近端）。分析BME与年龄，病因、ARCO分期、疼痛分组、坏死范围以及股骨头塌陷之间的相关性；运用多个独立样本非参数检验和列联表X^2检验。[结果]BME与年龄、病因无相关性；各分期中BME分级的差异有显著意义（X^2=21．1，P=0．0003），各分期的BME发生有显著差异（X^2=28．51，P〈0．0001）；不同坏死范围中，BME分级有显著差异（X^2=9．77，P=0．021），但BME的发生无显著差异（X^2=6．227，P=0．101）；股骨头塌陷与BME分级无相关性（F=2．558，P=0．465），但BME的发生与股骨头塌陷有相关性（X^2=22．799，P〈0．001）；不同疼痛程度中BME分级有显著性差异（X^2=26．66，P〈0．001），BME的发生与疼痛程度有相关性（X^2=40．855，P〈0．001）。[结论]BME的发生与年龄、病因无相关性；BME弥散程度与坏死范围、疼痛程度、股骨头塌陷存在相关性，BME的发生与坏死范围无关，与疼痛、塌陷密切相关；BME可能是由股骨头塌陷所导致的病理改变。     

强化力学结构治疗股骨头坏死的实验研究

目的探讨髓芯减压术后利用同种异体骨支撑架结合自体骨和脱钙骨基质（DBM）植入治疗股骨头坏死的可行性。方法取大尾羊22只，其中2只作为正常对照组，其余20只建立双侧股骨头坏死模型，4周后随机挑选2只检测股骨头坏死情况，确定造模成功后，将其余18只（36侧）随机分为A、B、C三组，每组6只（12侧），A组单纯行髓芯减压，B组在行髓芯减压后植入自体松质骨和DBM，C组在行髓芯减压后植入同种异体骨支撑架、自体松质骨和DBM。分别于术后5、10和20周对股骨头行影像学检查、生物力学测试和组织学观察。结果影像学检查和组织学观察结果显示C组在髓芯减压区骨缺损修复及成骨方面较B组略高，但差异无统计学意义（P〉0．05）；B、C两组都较同时期的A组明显增强，差异有统计学意义（P〈0．05）。生物力学测试结果表明，术后5、10、20周时C组力学强度较A、B两组明显增高，差异有统计学意义（P〈0．05），在10、20周时C组股骨头生物力学强度和正常股骨头无明显差异。结论应用同种异体骨支撑架结合自体骨和DBM治疗股骨头坏死，能有效加强股骨头的力学结构、促进坏死骨的修复及防止股骨头关节面的塌陷。     

促血管生成素家族在大肠腺癌中的表达及与微血管密度和临床病理特征的关系

目的 探讨促血管生成素-1（Ang-1）、促血管生成素-2（Ang-2）、促血管生成素受体（Tie-2）及血管内皮生长因子（VEGF）在大肠腺癌及癌旁正常组织中的表达，及与微血管密度（MVD）和临床病理特征的关系。方法 采用免疫组织化学方法检测Ang-1、Ang-2、Tie-2及VEGF在45例大肠腺癌及10例癌旁正常组织中的表达。结果 大肠腺癌组织中的Ang-2蛋白及VEGF蛋白明显高于癌旁正常组织（P〈0．01），腺癌的分化程度越低，Ang-2及VEGF蛋白的表达率越高（P〈0．05），Ang-2与VEGF蛋白的表达存在明显正相关性（r=0．997，P〈0．01）；大肠腺癌组织中的Ang-1蛋白明显低于癌旁正常组织（P〈0．01），腺癌的分化程度越高，Ang-1蛋白的表达率越高（P〈0．05）；Tie-2蛋白在大肠腺癌和癌旁正常组织中的表达差异无统计学意义（P〉0．05）。大肠腺癌的分化程度越低，MVD越高（P〈0．05），腺癌组织中Ang-1蛋白阳性表达组MVD明显低于阴性表达组（P〈0．01），Ang-2蛋白阳性表达组MVD明显高于阴性表达组（P〈0．01）。≥5cm及有淋巴结转移的大肠腺癌组织中，Ang-2蛋白的表达明显增加（x^2=8．889，P〈0．01；x^2=10．020，P〈0．01）。结论 在大肠腺癌组织中，相对Ang-1占优势的Ang-2的过度表达，可能在肿瘤的血管生成和进展过程中起着重要作用。     

高龄股骨粗隆间骨折治疗方法的选择

目的：探讨治疗高龄股骨粗隆间骨折的方法选择。方法：1997年6月-2003年5月治疗高龄股骨粗隆间骨折115例，男48例，女67例；年龄62～90岁，平均76．1岁。按Evan分型：Ⅰ型22例，Ⅱ型24例，Ⅲ型34例，Ⅳ型27例，Ⅴ型8例。采用骨牵引15例，多枚折尾钉固定32例，动力髋螺钉内固定47例。结果：经12～34个月（平均22个月）的随访，共有94例获完整随访资料。所有病例均骨折愈合，依据疗效标准：骨牵引组（A组）优2例，良6例，可5例，差2例；多枚折尾钉组（B组）优11例，良17例，可4例；动力髋螺钉组（C组）优18例，良22例，可6例，差1例。A组优良率明显低于B组（x^2=4．881）和C组（x^2=4．875），差异有显著性意义（P〈0．05）；B组和C组疗效差异无显著性（x^2=0．352，P〉0．05）；功能恢复时间A组长于B组（F=213．422）和C组（F=260．809），有显著性差异（P〈0．05），B、C组间无显著性差异（F=1．427，P〉0．05）；A、B、C三组分别有6、2和4例发生髋内翻．A组显著高于B、C两组（x^2=6．020，6．170，P〈0．05），B、C两组间无显著性差异（x^2=0，P〉0．05）。结论：及时有效的内固定是治疗高龄股骨粗隆间骨折的基本原则。EvanⅠ、Ⅱ型骨折以多枚折尾钉内固定为首选，EvanⅢ、Ⅳ、Ⅴ型（逆粗隆间骨折）以动力髋螺钉为最佳，骨牵引治疗效果明显低于内固定者。     

酒精灭活性股骨头坏死犬模型中松质骨骨矿密度和三维结构的变化

目的测量三足负重酒精灭活性股骨头坏死犬模型的股骨头松质骨的矿物质密度和骨小梁的三维结构变化，初步探讨局部注射酒精和负重对股骨头力学强度的影响。方法取健康成年Beagle犬24只，体重18～23kg。随机取12只犬建立三足负重犬动物模型，余12只不作任何处理，为四足犬。所有动物随机取一侧后肢为实验侧，于股骨头内局部注射无水酒精，建立股骨头坏死犬动物模型；对侧为对照侧，股骨头内注入等量生理盐水。将三足和四足犬对照侧作为对照组，三足犬实验侧为三足犬组，四足犬实验侧作为四足犬组。于髋部注射酒精后1、3、6及12周处死动物，取双后肢股骨头行Micro-CT扫描。以股骨头内钻孔针道为中心，自针道边缘由中心向外各选取相互连接的直径为1mm的圆柱形区域，依次命名为Ⅰ、Ⅱ和Ⅲ区。对各区的骨矿密度（bone mineral density，BMD）、骨体积分数（bone volume fraction，BVF）、骨矿容量（bone mineral content，BMC）、骨表面积与骨骼体积比（bone surface to bone volume ratio，BS／BV）、结构模型指数（structure model index，SMI）、骨小梁厚度（trabecular plate thickness，Tb．Th）、骨小梁数目（trabecular plate number，Tb．N）、骨小梁间隙（trabecular spacing，Tb．Sp）进行测量和比较；对股骨头软骨下骨区行三维重建，观察其三维结构变化。结果注射酒精后1周各组各项参数差异均无统计学意义（P〉0．05）。3周，三足犬和四足犬组Ⅰ、Ⅱ和Ⅲ区的BMC、BMD、BVF及BS／BV自针道向外逐渐递增，各区间差异有统计学意义（P〈0．05）。6周，三足犬组和四足犬组Ⅰ、Ⅱ区的BMC、BMD、BVF和Tb．N较Ⅲ区明显下降，Tb．Sp较Ⅲ区增加，差异有统计学意义（P〈0．05）。12周，对照组、三足犬组和四足犬组3区的各项参数差异无统计学意义（P〉0．05）。注射酒精后3周，BMC、BMD和BVF在三足犬组和四足犬组开始下降，与1周比较差异有统计学意义（P〈0．05）；6周，下降最明显，BMC与1、3周比较，差异有统计学意义（P〈0．05），BMD与BVF差异无统计学意义（P〉0．05），12周与6周比较，差异无统计学意义（P〉0．05）。三足犬组股骨头内注射酒精后，随时间延长，骨小梁结构逐渐变细、密度降低、间隙增宽、12周时可观察到局部骨小梁的连续性破坏和骨小梁的断裂。结论局部注射酒精致犬股骨头坏死后，坏死骨质的吸收将导致骨小梁力学强度的下降。持续的生物应力将阻碍坏死后的修复反应，使坏死骨小梁的力学强度更为降低，是致坏死股骨头塌陷的重要原因。     

温固化水凝胶负载骨髓基质干细胞修复兔关节软骨缺损的实验研究

目的探讨温同化水凝胶（Pluronic F—127）作为骨髓基质干细胞的载体修复软骨缺损的可行性。方法将培养的骨髓基质干细胞与400g/L浓度的温化水凝胶混合后移植到兔膝关节软骨缺损中，分别于术后4、8、12周观察大体标本及组织学修复结果。结果实验组的缺损为透明软骨修复；单纯材料组和空白对照组以纤维组织修复。参考Wakitani制定的组织学评分标准，Pluronic F-127组和空白对照组的组织学评分在各个时期无显著的差异（P〉0．05），而实验组和空白组在各个时期均存在显著的差异（P〈0．05）。结论Pluronic F-127可作为软骨组织工程良好的支架材料。     

股骨头骨髓水肿综合征的诊治及其与股骨头缺血性坏死的鉴别诊断

目的：通过对股骨头骨髓水肿综合征诊治的观察,分析其疾病特点及其与股骨头缺血性坏死的异同。方法：自2004年1月,股骨头骨髓水肿综合征患者19例,男12例,女7例;平均年龄（46．7±10．36）岁。给予药物及物理治疗,治疗前后按照髋关节Harris评分系统进行评分。结果：治疗前平均（43．17±12．62）分,治疗后平均（86．73±14．29）分,治疗前、后评分差异有统计学意义（P〈0．05）。结论：股骨头骨髓水肿综合征疾病特点不同于股骨头缺血性坏死,是一类独立的疾病。     

骨髓水肿与股骨头塌陷及疼痛的相关性研究

目的 探讨股骨头缺血性坏死骨髓水肿的发生机制及其与疼痛程度和塌陷的关系.方法 对2006年1月至200r7年10月资料齐全的股骨头缺血性坏死患者共91例(165髋)进行回顾性分析,改良Merle d'Aubigne评分统计每髋的疼痛程度.并对16例(16髋)有骨髓水肿的患者行MRI随访.结果 165髋中47髋出现骨髓水肿,发生于ARCO分期Ⅱ期13髋,Ⅲ期34髋,各期出现骨髓水肿差异有统计学意义(P＜0.05).T2加权像和STIR像均出现骨髓水肿37髋,仅STIR像出现骨髓水肿10髋.40髋骨髓水肿在症状出现后6个月内发现.7髋骨髓水肿在症状出现后7～15个月内发现.Ⅱ期髋关节,伴骨髓水肿者平均疼痛评分为2.46±0.66,无骨髓水肿者为5.21±1.12,疼痛评分差异有统计学意义(P＜0.05).Ⅲ期髋关节,伴骨髓水肿者平均疼痛评分为2.38±0.78,无骨髓水肿者为3.63±0.93,疼痛评分差异有统计学意义(P＜0.05).结论 骨髓水肿发现于股骨头缺血性坏死的Ⅱ、Ⅲ期,其发生与股骨头塌陷明显相关,多发生于症状出现后6个月内,其疼痛程度较同期无骨髓水肿的股骨头重.STIR成像能更敏感地发现骨髓水肿.     

Knochenmarködem im Kniegelenk

The Bone marrow edema (BME) is a common finding when evaluating patients with knee pain by magnetic resonance imaging (MRI). The typical signal patterns of BME are unspecific and can be found with different diseases of the knee. Since different therapeutic approaches are mandatory, differential diagnosis of the several forms of BME is important. In this review, painful BME will be separated into three different etiological groups. Group 1 ischemic BME: osteonecrosis, osteochondritis dissecans, bone marrow edema syndrome and complex regional pain syndrome. Group 2 mechanical BME: bone bruises, microfracture, stress-BME und stress fracture. Group 3 reactive BME: inflammatory gonarthritis, degenerative gonarthrosis, postoperative and tumours. The typical MRI morphologies and differential diagnosis of these BME manifestations will be described. The different therapeutic consequences will also be briefly mentioned.     

The transitory bone marrow edema syndrome of the hip

AIM OF THE STUDY: Since MRI-studies had begun to establish the diagnosis of transitory bone marrow edema syndrome of the hip orthopedic surgeons have tried to integrate this new syndrome into the internationally accepted system of musculoskeletal diseases. Particularly, the relation to non-traumatic osteonecrosis of the femoral head and the possibilities in therapy were investigated in our clinical trial. METHODS: Our clinical trial encompassed 106 patients suffering from the transitory bone marrow edema syndrome diagnosed in our department between the years 1985 and 2000. In order to confirm this diagnosis we used the patients' histories, their clinical courses, MRI studies, scintigraphic bone scans, intraosseal pressure measurements, phlebographies, laboratory data, and histologic specimens. One half of our collective positive for transient bone marrow edema of the hip underwent core-decompression surgery (50 patients), the other half (56 patients) was treated conservatively by analgesic medication combined with restriction of weight-bearing in the affected extremity. RESULTS: Patients positive for transitory bone marrow edema syndrome of the hip are middle-aged individuals with a male to female predominance of 60 : 40. This group has no or only few risk factors usually associated with osteonecrosis of the femoral head. Thus, the missing alcoholic abuse is striking. All patients suffering from transitory bone marrow edema syndrome of the hip recovered completely independent of the therapy we initiated and none of them showed any signs of osteonecrosis. The one half undergoing surgical decompression of the edema by using a 4.5 mm drill experienced an markedly accelerated relief of their clinical symptoms as well as their signal changes on MRI studies. Conventional X-ray pictures and scintigraphic bone scans are not useful for early differentiation between early stages of osteonecrosis and bone marrow edemas. This also accounts for the historical measurements of intraosseal pressure determinations and phlebographies. In contrast to that, MRI studies are effective in early differentiation between osteonecrosis and bone marrow edema syndrome of the hip, especially when contrast medium (gadolinium) is administrated intravenously and fat-suppressed MRI-sequences find use. Beginning osteonecrosis of the femoral head shows a segmental loss of contrast medium, a "double line sign" interface to the intact bone marrow, and only in a few cases they are associated with a huge symptomatic edema. The histologic examination of specimens obtained from 43 patients with transitory bone marrow edema syndrome of the hip revealed no signs of osteonecrosis. CONCLUSION: MRI studies are useful in differentiation between bone marrow edema syndrome of the hip and non-traumatic osteonecrosis of the femoral head in each stage of these two diseases. The thorough differentiation between these two diseases is of extraordinary importance for the clinical work-up of the patients as well as for scientific reasons. The course of primary bone marrow edema is benign as it results in entire recovery. The core decompression surgery offers the chance to shorten the course of the disease.     

Bone marrow edema in the knee. Differential diagnosis and therapeutic possibilities

The Bone marrow edema (BME) is a common finding when evaluating patients with knee pain by magnetic resonance imaging (MRI). The typical signal patterns of BME are unspecific and can be found with different diseases of the knee. Since different therapeutic approaches are mandatory, differential diagnosis of the several forms of BME is important. In this review, painful BME will be separated into three different etiological groups. Group 1 ischemic BME: osteonecrosis, osteochondritis dissecans, bone marrow edema syndrome and complex regional pain syndrome. Group 2 mechanical BME: bone bruises, microfracture, stress-BME und stress fracture. Group 3 reactive BME: inflammatory gonarthritis, degenerative gonarthrosis, postoperative and tumours. The typical MRI morphologies and differential diagnosis of these BME manifestations will be described. The different therapeutic consequences will also be briefly mentioned.     

Das Knochenmarködemsyndrom (KMÖS)

Bone marrow edema (BME) syndrome represents a pathologic accumulation of interstitial fluid in bone – with a traumatic BME being differentiated from a non-traumatic, often ischemic, and a reactive as well as a mechanical BME. Atraumatic/ischemic BME is inconsistently described as a separate entity or as a reversible preliminary stage of osteonecrosis (ON). However, there is always the risk of transformation of BME into ON and subsequent joint destruction. The most common sites of BME are the hip, knee, and ankle. Magnetic resonance imaging is the diagnostic gold standard. Differential diagnoses of the transient BME as osteonecrosis, osteochondrosis dissecans, and a reflex dystrophy should be considered. Conservative or surgical treatment is considered, depending on the etiology of BME. BME syndrome is generally treated conservatively. Infusion of prostacycline or bisphosphonates is a promising option. Ischemic BME and early stages of ON can be successfully treated by core decompression. A combination of both treatment options may also offer advantages.     

Bone marrow edema in the foot—MRI findings after conservative therapy

Bone marrow edema (BME) is a rare cause of pain in the foot. We reviewed 23 patients with unilateral idiopathic bone marrow edema located in the foot. The patients' mean age was 59.1 years (32–73). Bone marrow edema was located 12 times in the talus, four times in the cuneiform bones, four times in the metatarsal bones, two times in the calcaneus, and once in the navicular bone. Edema secondary to an activated osteoarthritis, to mechanic stress, to a chronic regional pain syndrome or to trauma were excluded. The size of BME was categorized large in nine cases (50–100% of the bone involved), in nine cases medium (25–50%) and in five cases small (<25%).Conservative therapy consisted of infusions with the vasoactive substance iloprost and limited weight-bearing for a period of three weeks. After 3 months, in 15 patients BME showed total regression on MRI scan. In three there was subtotal regression and in three no change in the size of the BME (p<0.0001).No correlation between the primary size of BME and outcome was seen (p=0.453). No progression to AVN occurred in our patients. In two patients BME appeared to migrate to neighbouring bones and in one patient to a femoral head.Conclusions. Bone marrow edema syndrome is rarely seen in the foot. Progress to avascular necrosis is unlikely. Conservative therapy can be recommended.     

Increased perfusion of the femoral head in transient bone marrow edema syndrome

The pathophysiology of transient bone marrow edema syndrome is not known. Ischemia has been suggested as the pathophysiologic factor, because the histologic findings are similar to those of early stage osteonecrosis. Angiographic studies of osteonecrotic femoral heads have shown arterial interruption and impaired perfusion. The current report describes the angiographic and scintigraphic findings of transient bone marrow edema syndrome of the hip in a 45-year-old man. The nutrient arteries were dilated, and the femoral head perfusion was increased compared with the unaffected contralateral side. These findings suggest that a vasomotor response plays a role in the pathogenesis of transient bone marrow edema syndrome. The disease might be a reversible process after temporary ischemia of the femoral head.     

髓芯减压联合高压氧治疗髋关节骨髓水肿综合征

目的探讨髓芯减压联合高压氧治疗髋关节骨髓水肿综合征（BMES）的疗效。方法髓芯减压联合高压氧治疗12例髋关节BMES患者。结果12例均获随访,时间6～24个月。患者疼痛均完全消失,术后4～12周髋关节功能恢复正常。随访期间未发现病情复发及股骨头坏死。结论髓芯减压联合高压氧治疗髋关节BMES,创伤小,并发症少,疗效好。     

Editorial Commentary: Spontaneous Insufficiency Fracture of the Knee,Formerly Known as Spontaneous Osteonecrosis of the Knee,May Benefit From Combined Mosaicplasty and High Tibial Osteotomy: Better Together

Spontaneous insufficiency fracture of the knee (SIFK) previously termed spontaneous osteonecrosis of the knee (SONK) is a painful knee condition that can occur spontaneously from unknown causes. Histology confirms that a subchondral insufficiency fracture is the true finding and osteonecrosis is a secondary and end-stage finding of the SIFK spectrum of disease. SIFK demonstrates a subchondral fracture and bone marrow edema (BME) on MRI and if left untreated, it can lead to collapse. SONK is most often diagnosed in middle-aged and older patients and is more common in females. It is usually found in the medial femoral condyle. Approximately one-third of patients progressed to total knee arthroplasty. Factors that contributed to disease progression included baseline arthritis, older age, location of the insufficiency fracture, meniscal extrusion, and varus malalignment. Positive outcomes have been reported when SIFK is treated with a combination of mosaicplasty (MOS) and high tibial osteotomy (HTO). And just as like MOS and HTO work better together, we need to collaborate to find solutions. We too are better together.     

Fatty marrow conversion of the proximal femoral metaphysis in transient bone marrow edema syndrome

Introduction In the proximal femoral metaphysis, hematopoietic marrow is predominant during the adult stage of life. The conversion of hematopoietic marrow to fatty marrow in the proximal femoral metaphysis has been suggested as an etiologic factor of ischemia in the pathogenesis of femoral head osteonecrosis. To determine whether the chronology of fatty marrow conversion of the proximal femoral metaphysis is related to transient bone marrow edema syndrome of the hip, a case control study was conducted on 10 patients with the disease.Materials and methods There were 8 men and 2 women with a mean age of 33 years (range 19–45 years). The 10 patients were matched with 20 controls for gender and age (5-year range). T1-weighted MRI scans of their hips were reviewed. Marrow of the greater trochanter becomes fatty before puberty, and thus, the greater trochanter can be used as a built-in control. The signal intensity of the proximal femoral metaphysis was compared to that of the greater trochanter.Results In all patients, the signal intensity of the proximal femoral metaphysis was isointense (fatty marrow) relative to that of the greater trochanter. In control subjects, the signal intensity was isointense in 8 (40%) and hypointense (hematopoietic marrow) in 12 (60%) (p<0.05).Conclusion The current study shows that the proximal femoral metaphysis is predominantly fatty in transient bone marrow edema syndrome. The conversion of hematopoietic to fatty marrow is known to correlate with decreases in intramedullary blood flow. Thus, the current study suggests that an ischemia of the proximal femur secondary to fatty marrow conversion of the proximal femoral metaphysis might be a cause of transient bone marrow edema syndrome of the hip.