SARS患者股骨头坏死范围、部位与激素用量的关系

目的 探讨SARS患者皮质类固醇用量与股骨头坏死范围及部位的关系.方法 回顾性分析34例SARS后股骨头坏死患者的病例资料.根据使用皮质类固醇总量将患者分为三组:A组小于3000mg,B组3000～5000mg,C组大于5000mg;根据日平均用量分为两组:1组小于160mg,2组大于160 mg.在使用激素后6个月所摄双髋MRI片h,测量冠状面及横断面上骨坏死角度,计算坏死指数,确定坏死范围.将坏死部位按Sugano方法分为A、B、C1、C2四部位.统计分析坏死部位、坏死范围与皮质类固醇用量的关系.结果 (1)激素总量与坏死范围之间的关系:A、B、C三组间坏死指数的差异无统计学意义.(2)激素日平均用量与坏死范围的关系:小于160 mg与大于160 mg两组的坏死范围差异无统计学意义.(3)坏死部位与坏死范围的关系:A部位、B部位、C1部位坏死指数的差异无统计学意义,均低于C2部位,与C2部位比较差异均有统计学意义.结论 骨坏死的范围与皮质类同醇总用量或日平均用最无关.小范围的骨坏死一般发生于髋臼缘内侧相对应的股骨头部分,超出髋白缘者坏死范围均较大.

The relationship of the range and location of osteonecrosis of the femoral head with the dose of steroid in SARS patients

Objective To explore the relationship of the necrosis range and location of osteonecrosis of femoral head with the dose of steroid. Methods Thirty-four cases with steroid induced osteonecrosis of femoral head after SARS were included, collected the dosage of steroid of all cases. All the cases were divid-ed into three groups according to the gross of the steroid, A group <3000 mg, B group 3000-5000 mg, C group >5000 rag. The cases were divided into two groups according to the every day average dosage of the steroid: 1 group <160 mg, 2 group >160 mg. All hips were examined with MRI to survey the angle of necro-sis in the mid-coronal image and mid-cross section image, then the range of necrosis were evaluated through calculating the necrosis index (NI) after 6 months with steroid. The cases were divided into A, B, C1, C2 four groups according to location of necrosis that Sugano suggested to explore the relationship of the range and the location of necrosis. Results 1) The relationship of the steroid gross and the range of necrosis: no signif- icance in NI among A, B and C groups. 2) The relationship of the every day average dosage of the steroid and the range of necrosis: no significance in NI between group 1 and group 2. 3) The relationship between the range and the location of necrosis: no significance in NI between groups A, B, C1. The NI of the three areas respectively was significantly less than that at C2 area. Conclusion 1) There is no positive correla-tion between the range of necrosis and the steroid gross or the every day average dosage of the steroid. 2)The small range necrosis occurred in femoral head that matched along with the medial part of the edge of the acetabulum, the range of necrosis is big if the necrosis extending to the lateral of the acetabular edge.