8例髋关节暂时性骨质疏松症的临床诊断与治疗

目的探讨髋关节暂时性骨质疏松症（transient osteoporosis of the hip，TOH）的临床表现、诊断、鉴别诊断、治疗及预后。方法2003年8月至2009年8月治疗8例TOH患者，男2例，女6例；年龄22—43岁，平均34．9岁。患者均为单侧发病，左侧5例，右侧3例。患者的患髋均表现有不同程度的突发急性疼痛或渐进性疼痛，同时伴有显著的跛行。患髋内旋轻度受限是主要的体征。症状出现后3—6周，x线片可见股骨头均匀广泛的骨质疏松，MR表现为弥散且一致的等低T1、长T2异常信号，脂肪抑制序列呈高信号。嘱患者在疼痛可忍受的条件下半负重行走，避免出现骨折等并发症；口服二膦酸盐和钙剂；剧烈疼痛时，可口服非甾体类抗炎药物缓解疼痛。结果临床治疗3个月后疼痛明显减轻，10个月后疼痛完全缓解，复查MR示病变完全消失。结论TOH是一种少见的疾病，无原因出现的髋关节疼痛和跛行是主要症状，X线片和MR可分别看到暂时性的骨质疏松和骨髓水肿。此病具有自限性，保守治疗可获得良好的结果，明确诊断是治疗的关键。

Transient osteoporosis of the hip: diagnosis and treatment of 8 cases

Objective To summarize the clinical outcomes of the transient osteoporosis of the hip （TOH）. Methods Eight patients with TOH were retrospectively analyzed. They were diagnosed according to the clinical, radiographic and MR features. All patients underwent conservative treatments. Results Patients typically had spontaneous hip pain without apparent reasons. Antalgic gaits and limitations of internal rotation of the affected hip joint were the major findings in physical examinations. Plain radiographs of the hip typically demonstrated diffused osteoporosis of the femoral head and neck, although signs may not be evident in the early phases of the disease. MR is helpful to confirm the diagno- sis of transient osteoporosis. The typical MR findings were bone marrow edema of the femoral neck with diffuse decreased signal intensity on T1-weighted images and diffuse increased signal intensity on T2-weighted images. Within 6 to 12 months after the onset of the symptoms, the disease typically resolved spontaneously, and the radiographs demonstrated reconstitution of normal bone density. Conclusion TOH is an uncommon idiopathic condition characterized by spontaneous onset of hip pain associated with radiographic osteoporosis of the femoral head and neck. Resolution is spontaneous, usually within 6 to 12 months. As a benign process, TOI-1 does not progress into osteonecrosis, and should be treated conservatively.