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中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 578 -585. doi: 10.3877/cma.j.issn.1674-134X.2021.05.009

综述

快速破坏性髋关节疾病诊断及其特点研究
万贤杰1, 侯卫坤2, 许珂2, 杨明义1, 马尧1, 马宇杰1, 许鹏2,()   
  1. 1. 716000 延安大学;710054 西安交通大学附属红会医院
    2. 710054 西安交通大学附属红会医院
  • 收稿日期:2021-05-11 出版日期:2021-10-01
  • 通信作者: 许鹏
  • 基金资助:
    国家自然科学基金(81772410,81601877); 中国博士后科学基金(2020M673454)

Study on diagnosis and characteristics of rapidly destructive hip joint diseases

Xianjie Wan1, Weikun Hou2, Ke Xu2, Mingyi Yang1, Yao Ma1, Yujie Ma1, Peng Xu2,()   

  1. 1. Yan′an University, Yan′an 716000, China; Honghui Hospital, Xi′an Jiaotong University, Xi′an 710054, China
    2. Honghui Hospital, Xi′an Jiaotong University, Xi′an 710054, China
  • Received:2021-05-11 Published:2021-10-01
  • Corresponding author: Peng Xu
引用本文:

万贤杰, 侯卫坤, 许珂, 杨明义, 马尧, 马宇杰, 许鹏. 快速破坏性髋关节疾病诊断及其特点研究[J]. 中华关节外科杂志(电子版), 2021, 15(05): 578-585.

Xianjie Wan, Weikun Hou, Ke Xu, Mingyi Yang, Yao Ma, Yujie Ma, Peng Xu. Study on diagnosis and characteristics of rapidly destructive hip joint diseases[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(05): 578-585.

快速破坏性髋关节疾病是一类在骨科疾病中比较少见的疾病,该类疾病病程进展迅速,早期各类检查与一般常见的髋关节疾病并无差异,但是常常在极短的时间内出现髋关节的严重破坏。因此临床上常常出现漏诊,误诊等现象,导致延误病情诊疗。国内目前缺少系统分析快速破坏性髋关节疾病诊断及其特点的文献。快速破坏性髋关节疾病好发于老年女性,多单侧发病,病情进展迅速。但目前发病机制尚不明确,主要有生物应力改变、软骨下不全骨折合并骨质疏松症、破骨细胞异常活跃和药物毒理反应等学说。该病主要以病史和影像学检查作为诊断依据,实验室检验多为阴性可以作为诊断参考。因该病早期诊断较为困难,故该病的治疗主要以中晚期的全髋关节置换术作为主要治疗手段。本文就该病近年来的研究进行综述,为临床上该疾病的诊断和治疗提供帮助。

Rapidly destructive hip disease is a relatively rare disease in orthopaedics, the course of this kind of disease is rapid, and there is no difference between early examination and common hip disease. However, serious damage to the hip joint often occurs in a very short period of time. Therefore, missed diagnosis and misdiagnosis often occur in clinic, resulting in delay in diagnosis and treatment of the disease. At present, there is a lack of literature on the systematic analysis of the diagnosis and characteristics of rapid destructive hip diseases in China. Rapidly destructive hip disease often occurs in elderly women, mostly unilateral, and the disease progresses rapidly. But the pathogenesis is not clear, which mainly includes biological stress changes, subchondral incomplete fracture complicated with osteoporosis, abnormal activity of osteoclasts and drug toxicological reaction, etc. The diagnosis of the disease is mainly based on medical history and imaging examination, and most of the laboratory tests are negative which can be used as a reference for diagnosis. Because the early diagnosis of the disease is difficult, the treatment of the disease is mainly the middle and late stage of total hip arthroplasty as the main treatment. This article reviewed the recent studies of the disease and provided help for the clinical diagnosis and treatment of the disease.

图1 X线片上的RDHD(快速破坏性髋关节疾病)改进分型。图A为间隙缩窄型;图B为骨萎缩型;图C为骨崩解碎裂型;图D为骨吸收型
[1]
姚利兵,王丰爱,杨建安.罕见双髋快速破坏性骨关节病一例报道[J/CD].中华关节外科杂志(电子版)20148(1):124-126.
[2]
Rosenberg ZS, Shankman S, Steiner GC, et al. Rapid destructive osteoarthritis: clinical, radiographic, and pathologic features[J]. Radiology, 1992, 182(1): 213-216.
[3]
Lequesne M, Ray G. Rapid idiopathic destructive coxarthrosis. Prospective etiologic study of 27 cases[J]. Rev Rhum Mal Osteoartic, 1989, 56(2):115-119.
[4]
Depuyt F, Van Holsbeeck M. Rapidly destructive coxarthrosis:case study and literature review[J]. J Belge Radiol, 1990, 73(3): 207-210.
[5]
Ogawa K, Mawatari M, Komine M, et al. Mature and activated osteoclasts exist in the synovium of rapidly destructive coxarthrosis[J]. J Bone Miner Metab, 2007, 25(6): 354-360.
[6]
Solomon L, Schnitzler CM, Browett JP. Osteoarthritis of the hip:the patient behind the disease[J]. Ann Rheum Dis, 1982, 41(2): 118-125.
[7]
Ryu KN, Kim EJ, Yoo MC, et al. Ischemic necrosis of the entire femoral head and rapidly destructive hip disease: potential causative relationship[J]. Skeletal Radiol, 1997, 26(3): 143-149.
[8]
Kim KK. Regional distribution of stress on the distal femur in advanced osteoarthritis[J]. J Bone Metab, 2018, 25(3): 175-180.
[9]
Watanabe W, Itoi E, Yamada S. Early MRI findings of rapidly destructive coxarthrosis[J]. Skeletal Radiol, 2002, 31(1): 35-38.
[10]
Motomura G, Yamamoto T, Nakashima Y, et al. Outcome of the contralateral hip in rapidly destructive arthrosis after total hip arthroplasty: a preliminary report[J]. J Arthroplasty, 2006, 21(7): 1026-1031.
[11]
Fukui K, Kaneuji A, Fukushima M, et al. Early MRI and intraoperative findings in rapidly destructive osteoarthritis of the hip: a case report[J]. Int J Surg Cas Rep, 2015, 8C:13-17.
[12]
贾炬川,张先龙.快速破坏性髋关节病发病机制的研究进展[J].中华解剖与临床杂志201924(6): 626-628.
[13]
童培建,季卫锋,吴云刚,等. 快速破坏的髋关节病18例分析[J]. 中华风湿病学杂志2003(04):238-241.
[14]
Mitrovic DR, Riera H. Synovial, articular cartilage and bone changes in rapidly destructive arthropathy (osteoarthritis) of the hip[J]. Rheumatol Int, 1992, 12(1): 17-22.
[15]
Yamakawa T, Sudo A, Tanaka M, et al. Microvascular density of rapidly destructive arthropathy of the hip joint[J]. J Orthop Surg (Hong Kong), 2005, 13(1): 40-45.
[16]
Soskolne WA. The osteoclast-endothelium interface during bone resorption in the femurs of young rabbits[J]. Cell Tissue Res, 1979, 203(3): 487-492.
[17]
Gurzu S, Turdean SG, Pop ST, et al. Different synovial vasculogenic profiles of primary, rapidly destructive and osteonecrosis-induced hip osteoarthritis. An immunohistochemistry study[J]. Int Orthop, 2017, 41(6): 1107-1112.
[18]
Subedi N, Chew NS, Chandramohan M, et al. Effectiveness of fluoroscopy-guided intra-articular steroid injection for hip osteoarthritis[J]. Clin Radiol, 2015, 70(11): 1276-1280.
[19]
Chu CR, Izzo NJ, Coyle CH, et al. The in vitro effects of bupivacaine on articular chondrocytes[J]. J Bone Joint Surg Br, 2008, 90(6): 814-820.
[20]
Hess SR, O′connell RS, Bednarz CP, et al. Association of rapidly destructive osteoarthritis of the hip with intra-articular steroid injections[J]. Arthroplast Today, 2018, 4(2): 205-209.
[21]
史云恒,钟志伟,韩殊曼,等.二例快速破坏性髋关节病临床、影像和病理特征分析[J].中华放射学杂志201751(6):471-472.
[22]
赵云鹤,赵拴柱,朱延兵,等.快速破坏性髋骨关节病的形态演变与治疗[J].中国矫形外科杂志200715(5):395-396,加4.
[23]
Zazgyva A, Gurzu S, Gergely I, et al. Clinico-radiological diagnosis and grading of rapidly progressive osteoarthritis of the hip[J]. Medicine, 2017, 96(12): e6395-e6395.
[24]
刘道兵,周宇,陈卫衡.快速破坏性髋关节病的临床及影像学特点分析[J].中国骨与关节损伤杂志201429(2):111-113.
[25]
姚利兵.髋关节快速破坏性骨关节病五例报告[J].中国骨与关节杂志20143(6):424-428.
[26]
王本超,陈森,彭昊,等.快速破坏性髋关节病国内外研究进展[J/CD].中华关节外科杂志(电子版)201812(3):374-378.
[27]
王跃庆,娄思权,孙锁拄. 突发性髋关节坏死1例报告[J]. 中国矫形外科杂志200311(22):1539-1539.
[28]
张麟,凃峰,张晨,王皓. 全髋关节置换治疗快速破坏性髋关节病的疗效分析. 中国中西医结合学会骨伤科专业委员会.2019楚天骨科高峰论坛暨第二十六届中国中西医结合骨伤科学术年会论文集[C].中国中西医结合学会骨伤科专业委员会:中国中西医结合学会,2019:363-363.
[29]
陈阳,陈伟民,卞传华.快速进展的股骨头缺血性坏死4例临床分析[J].吉林医学200728(5):587-587.
[30]
贾楠,惠萍,王新江,等.快速破坏性髋关节病2例[J].中国临床医学影像杂志201021(11):835-836.
[31]
贾学文,王毳,朱迎春,等. 快速破坏性髋关节病的诊断与治疗(附2例病例报告). 浙江省医学会骨科学分会.2012年浙江省骨科学术年会论文集[C].浙江省医学会骨科学分会:浙江省科学技术协会,2012:192-192.
[32]
陈振南,何亚标,孙俊明,等.快速破坏性髋关节病2例并文献复习[J].风湿病与关节炎202110(3):38-40, 57.
[33]
王斌. 有关快速破坏性髋关节病的探讨. 山西省医学会、山西医科大学第二医院.2017中国(太原)第四届世界骨科大会暨山西省第十九届骨科学术年会会刊[C].山西省医学会、山西医科大学第二医院:百奥泰国际会议(大连)有限公司,2017:270-270.
[34]
Matsunaga F, DeVita RR, Young PC. Rapidly destructive osteoarthritis of the hip[J]. Intern Emerg Med, 2021, 16(2): 497-499.
[35]
姚利兵,王丰爱,杨建安.罕见双髋快速破坏性骨关节病一例报道[J/CD].中华关节外科杂志(电子版)20148(1):124-126.
[36]
Birn J, Pruente R, Avram R, et al. Sonographic evaluation of hip joint effusion in osteoarthritis with correlation to radiographic findings[J]. J Clin Ultrasound, 2014, 42(4): 205-211.
[37]
Tiwari A, Karkhur Y, Keeney JA, et al. Rapid destructive osteoarthritis of the hip after intra-articular steroid injection[J]. Arthroplast Today, 2018, 4(2): 184-186.
[38]
Huerfano E, Bautista M, Bonilla G, et al. A case of rapidly destructive osteoarthritis of the hip with onset of less than six weeks[J]. J Clin Orthop Trauma, 2017, 8(Suppl 1): S72-S75.
[39]
Abe H, Sakai T, Ogawa T, et al. Characteristics of bone turnover markers in rapidly destructive coxopathy[J]. J Bone Miner Metab, 2017, 35(4): 412-418.
[40]
Boutry N, Paul C, Leroy X, et al. Rapidly destructive osteoarthritis of the hip: Mr imaging findings[J]. AJR Am J Roentgenol, 2002, 179(3): 657-663.
[41]
王镜山.进展型股骨头坏死患者血清抗酒石酸酸性磷酸酶5b及Ⅱ型胶原C-末端肽的表达及意义[J].广东医学201536(23):3690-3692.
[42]
梅杰,彭昊,尹东.快速进展型股骨头坏死患者血清骨代谢生化指标的变化[J].中国组织工程研究与临床康复201115(48):9116-9120.
[43]
Komiya S, Inoue A, Sasaguri Y, et al. Rapidly destructive arthropathy of the hip. Studies on bone resorptive factors in joint fluid with a theory of pathogenesis[J]. Clin Orthop Relat Res, 1992, (284):273-82.
[44]
Garnero P, Charni N, Juillet F, et al. Increased urinary type II collagen helical and C telopeptide levels are independently associated with a rapidly destructive hip osteoarthritis[J]. Ann Rheum Dis, 2006, 65(12):1639-1644.
[45]
刘晓宁,鞠阳,孔德明,等.快速破坏性髋关节骨关节炎患者体重、身高指数及骨密度分析[J].中国骨质疏松杂志201319(9):970-972.
[46]
严广斌.快速破坏性髋关节病[J/CD].中华关节外科杂志(电子版)201812(03):443-443.
[47]
侯黎升,阮狄克,何勍.夏科氏关节(Charcot关节)病的诊断与治疗[J].实用骨科杂志200511(1):49-52.
[48]
赖爱云,吕昭萍,徐健,等.神经性关节病一例[J].中华风湿病学杂志200913(10):724-725.
[49]
Bekki S. The pathogenesis of rapidly destructive coxarthrosis[J]. Nihon Seikeigeka Gakkai Zasshi, 199165(9):720-730.
[50]
Tanaka S. Emerging anti-osteoclast therapy for rheumatoid arthritis[J]. J Orthop Sci, 2018, 23(5): 717-721.
[51]
Xie Y, Pan M, Gao Y, et al. Dose-dependent roles of aspirin and other non-steroidal anti-inflammatory drugs in abnormal bone remodeling and skeletal regeneration[J/OL]. Cell Biosci, 2019, 23, 9: 103. doi: 10.1186/s13578-019-0369-9.
[52]
Kekatpure AL, Sun JH, Sim GB, et al. Rapidly destructive arthrosis of the shoulder joints: radiographic, magnetic resonance imaging, and histopathologic findings[J]. J Shoulder Elbow Surg, 2015, 24(6): 922-927.
[53]
Shu J, Ross I, Wehrli B, McCalden RW, Barra L. Rapidly destructive inflammatory arthritis of the hip[J/OL]. Case Rep Rheumatol, 2014, 2014:160252. doi: 10.1155/2014/160252.
[54]
Watarai K, Taneda H, Higano M, et al. Rapidly destructive arthrosis of the hip joint after insufficiency fracture of the acetabulum[J]. J Orthop Sci, 2008, 13(6): 561-565.
[55]
Yun HH, Song SY, Park SB, et al. Rapidly destructive arthropathy of the hip joint in patients with rheumatoid arthritis[J]. Orthopedics, 2012, 35(6): e958-e962.
[56]
Hamada T, Yamamoto T, Shida J, et al. Subchondral insufficiency fracture of the femoral head in a patient with alkaptonuria[J]. Skeletal Radiol, 2014, 43(6): 827-830.
[57]
Mavrogenis AF, Flevas DA, Panagopoulos GN, et al. Rapid destructive arthritis of the hip revisited[J]. Eur J Orthop Surg Traumatol, 2015, 25(7): 1115-1120.
[58]
Hu L, Zhang X, Kourkoumelis N, et al. The mysteries of rapidly destructive arthrosis of the hip joint: a systemic literature review[J]. Ann Palliat Med, 2020, 9(3): 1220-1229.
[59]
张麟,凃峰,张晨,王皓. 髋关节镜在快速破坏性髋关节病诊断中的价值分析. 中国中西医结合学会骨伤科专业委员会.2019楚天骨科高峰论坛暨第二十六届中国中西医结合骨伤科学术年会论文集[C].中国中西医结合学会骨伤科专业委员会:中国中西医结合学会,2019:507-507.
[60]
Hama S, Inori F, Momose D, et al. Total Hip Arthroplasty for rapidly destructive coxarthrosis in a patient with severe platelet deficiency due to liver cirrhosis and immune thrombocytopenic Purpura[J/OL]. Case Rep Orthop, 2015:469879. doi:10.1155/2015/469879.
[61]
Song JH, Han SK, Lee KH, et al. Comparison of perioperative blood loss in primary non-cemented total hip arthroplasty for rapidly destructive coxarthrosis and osteonecrosis of the femoral head[J]. Hip Pelvis, 2015, 27(3): 141-145.
[62]
Charrois O, Kahwaji A, Vastel L, et al. Blood loss in total hip arthroplasty for rapidly destructive coxarthrosis[J]. Int Orthop, 2001, 25(.1): 22-24.
[63]
Kubo Y, Motomura G, Ikemura S, et al. Osteoclast-related markers in the hip joint fluid with subchondral insufficiency fracture of the femoral head[J]. J Orthop Res, 2018, 36(11): 2987-2995.
[64]
刘晓宁,鞠阳,路露,等.快速破坏性髋关节骨关节炎人工全髋关节置换术中失血量分析[J].中国骨与关节损伤杂志201934(2):146-147.
[65]
Yuasa T, Maezawa K, Nozawa M, et al. Midterm outcome of total hip arthroplasty for rapidly destructive coxarthrosis[J]. J Orthop Surg (Hong Kong), 2016, 24(1): 27-30.
[66]
闫功芳.快速破坏性髋关节病的诊断及其治疗方案研究[J].基层医学论坛201620(5):629-630.
[67]
唐竞,周一新,邵宏翊,等.人工全髋关节置换术治疗快速破坏性髋关节病疗效分析[J].中国矫形外科杂志201523(21):1925-1928.
[68]
张晨,张麟,凃峰,王皓. 快速破坏性髋关节病与维生素D的相关性分析. 中国中西医结合学会骨伤科专业委员会.2019楚天骨科高峰论坛暨第二十六届中国中西医结合骨伤科学术年会论文集[C].中国中西医结合学会骨伤科专业委员会:中国中西医结合学会,2019: 362.
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