妊娠后股骨头缺血坏死的早期诊治

目的：探讨妊娠后股骨头缺血坏死的早期诊断及髓芯减压的疗效。方法：回顾总结我院2004年12月-2008年3月收治的妊娠后股骨头缺血坏死5例8个髋关节的早期诊断情况及行股骨头髓芯减压后的疗效及转归。所有病例入院时均行X线及MRI检查,按Steinberg分期法分期,并行患髋Harris评分。术后1、2、3个月、6个月门诊随访,以后每年门诊随访至少1次。每次行X线片检查和Harris评分,必要时行MRI检查。随访观察比较患髋Harris评分变化及影像学进展。术后评价：股骨头坏死发生进展或塌陷视为钻孔减压失败;疼痛缓解,股骨头未塌陷,MRI信号基本恢复视为有效或好转。结果：平均随访2．5年（648个月）,5例8个髋关节疼痛均消失,髋关节功能恢复,Harris评分平均由术前62分提高到95分;X线片显示手术前后患髋均无明显骨质异常,股骨头外形正常。6髋MRI示术前股骨头T2相及抑脂相高信号影、T1相低信号影,2髋T1、T2均低信号影。术后3个月抑脂相股骨头高信号影消失;6个月时股骨头内紊乱信号影模糊,1年时恢复均匀一致。结论：磁共振成像（MRI）可早期诊断妊娠后股骨头缺血坏死;髓芯减压治疗疗效满意,关节疼痛消失,功能恢复,X线片及MRI影像学基本恢复正常。

Early Diagnosis and Therapy for Osteonecrosis of the Femoral Head Associated with Pregnancy

Objective： To evaluate early diagnosis and effect of core decompression for osteonecrosis of the femoral head associated with pregnancy. Methods：Five cases（including eight hips）of femoral head necrosis associated with pregnancy were early diagnosed and then had a core decompression procedure in our hospital from December 2004 to March 2008. All cases had radiographic and Magnetic resonance imaging examination when came into hospital, Harris hip score was also done. Steinberg classification was applied. Then the serial following up（the 1st, 2nd, 3ed, 6th month after operation, then one time per year）, Harris hip score, radiography were examination every time, if necessary Magnetic resonance imaging was examination. The change of Harris hip score,the radiographic progression,and the need for total hip replacement after operation were observed. If the femoral head collapses, we think the operation failed; if not and the pain relieved, we think successful. Results：The patients were followed up for an averaged 2.5 years. All cases completely relieved the preoperative pain,the function of hip joint recover normally,the Harris hip score have an average improvement of 33 points（from 62 points to 95 points）. Radiograph of the hip demonstrate normal pre or postoperation. Magnetic resonance imaging demonstrate preoperative decreased signal intensity on T1 weighted images and increased signal intensity on T2 STIR images,which become normal gradually One year after operation. Conclusion： Use of Magnetic resonance imaging may lead an earlier diagnosis of femoral head necrosis associated with pregnancy. There can be a prominent effect of core decompression for early femoral head necrosis associated with pregnancy. The pain relieved completely and the function of hip joint recover,radiograph and Magnetic resonance imaging become normal gradually.