严重急性呼吸综合征继发股骨头坏死的临床特征

目的 通过对严重急性呼吸综合征（SARS）患者出院后双侧股骨头核磁共振（MRI）的跟踪和疗效观察,了解股骨头坏死的临床特征.方法（1）对我院2002年12月～2003年6月收治的医务人员及有症状的SARS患者进行股骨头和膝关节MRI检查,并对存在股骨头坏死者6月后复查;（2）将患者根据检查结果分为坏死组和非坏死组进行回顾性分析.结果（1）检查MRI患者共40例,发现7例有股骨头坏死.（2）股骨头坏死早期症状是患肢的烧灼样疼痛,后期是活动性疼痛.（3）股骨头坏死的发生与氧合指数、激素使用累计总量、激素每天用量和激素使用总时间有关,其中激素每天剂量〉160 mg、累计总用量〉2 000 mg、使用时间52天以上,且存在低氧血症者容易出现股骨头坏死.（4）中西医治疗对早期患者有效.结论曾使用大剂量激素、尤其存在低氧血症者,一旦出现下肢烧灼样疼痛、下肢疲劳或活动性疼痛,需检查MRI,以便及时发现股骨头的坏死.

The clinic feature of osteonecrosis of the femoral head and the analysis of its casuses in severe acute respiratory syndrome

Objective To investigate the clinic feature and the causes of avascular necrosis of the femoral head in severe acute respiratory syndrome (SARS) patients.Methods (1) The screening of MRI of femoral head and knee join for the SARS patients who were medical workers or complained the symptomsrelative to avascular necrosis of the femoral head and a repeated MRI 6 monthes later was given for those with avascular necrosis of the femoral head. (2) The patients were divided into two groups: normal group and necrotic group and the causes of avascular necrosis of the femoral head were investigated.Results (1)Forty cases performed the MRI of femoral head and knee join and 7 cases with avascular necrosis of the femoral head were found. (2) There were relationships between the avascular necrosis of the femoral head and Oxygen Index (OI), the glucocorticoid (the accumulative dose, the daily dose and the duration) and the secondary infections in lower respiratory tract. The avascular necrosis of the femoral head pretended to present in those whose accumulative dose and daily dose were respectively higher than 2000mg and 160mg. (3) Logistic regression (backward) could not find any risk factor for avascular necrosis of the femoral head.Conclusion The femoral heads of those who had a history of administrating lucocorticoid (the accumulative dose and the daily dose were respectively higher than 2000mg and 160mg), especially those with complication of lower OI and an infectious disease, should be monitored. As soon as those patients complained the symptoms relative to the avascular necrosis of the femoral head, the MRI should be performed in time in order to found the avascular necrosis of the femoral head.