Objective: To evaluate the progress and influence factors of asymptomatic osteonecrosis of the femoral head(ONFH). Methods: MRI was performed on the contralateral hips of 174 patients with unilateral symptomatic ONFH who admitted at Department of Orthopaedics, the Second Affiliated Hospital of Xi'an Jiaotong University from January 2012 to December 2018. Eighty-three of 174 patients with unilateral ONFH were found suffering from contralateral ONFH(47.7%), of which 77 patients were followed up.There were 28 males and 49 females with age of 48.6 years (range: 21-73 years). The pathogenesis, ARCO classfication, areas and position of osteonecrosis were collected.Independent sample t test, χ(2) test, Fisher exact test, multivariate Logistic regression were used to analyze the potential influence factors. Results: Patients were followed up for 36.7 months. During the following up period, ARCO classification of 28 patients (36.4%) progressed.The progress of asymptomatic ONFH was not related to the gender, age and original ARCO classification, but related to the pathogenesis, position and area of osteonecrosis (all P<0.05). Conclusion: The progress of asymptomatic osteonecrosis is related to the pathogenesis, position and area of osteonecrosis,but most of asymptomatic ONFH will not progress.
目的： 探讨无症状股骨头坏死（ONFH）患者病情进展情况及影响因素。 方法： 2012年1月至2018年12月，对西安交通大学第二附属医院骨科收治的174例确诊单侧ONFH的患者进行双侧髋关节MRI检查，发现对侧髋关节无明显症状但MRI显示存在ONFH的患者83例（47.7%）。77例患者获得随访，回顾性分析77例患者的临床资料。其中男性28例，女性49例，年龄48.6岁（范围：21~73岁），收集患者病因、坏死区位置、国际骨微循环研究协会（ARCO）分期和范围等临床资料，并对其病情进展进行随访观察。采用t检验、χ(2)检验、秩和检验对临床资料进行单因素分析，并使用Logistic回归进行多因素分析，筛选影响患者病情进展的相关因素。 结果： 77例患者随访时间36.7个月（范围：3~75个月），随访中患者ARCO分期进展28例（36.4%）。单因素分析结果显示，ONFH无症状病例是否进展与患者性别、年龄和ARCO分期无关，与患者病因、坏死区位置和坏死区范围相关（P值均<0.05）。多因素分析结果显示，激素性ONFH、坏死区范围大、坏死区位于负重区为患者发生ARCO分期进展的独立预后因素。 结论： 多数无症状ONFH患者病情不会进展，病因、坏死区范围和位置与病情进展相关。.
Keywords: Asymptomatic diseases; Femoral head necrosis; Follow-up studies.