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目的探讨肾移植后股骨头缺血坏死的临床特点、诊断及治疗。方法24例肾移植患者术后0.7~7.8年并发股骨头缺血坏死,20例为单侧股骨头缺血坏死,4例为双侧股骨头缺血坏死。参照Ficat分期标准将股骨头缺血坏死分为0~Ⅳ期。24例患者肾移植后均接受含激素的免疫抑制治疗方案,所有患者在确诊股骨头缺血坏死后均快速减少激素的用量,并于2周内停用,在保守疗法无效的情况下行手术治疗。结果发病早期(Ⅰ~Ⅱa期)的临床表现为患侧膝关节、患侧髋区、腹股沟或大腿前面疼痛,进展期(Ⅱb~Ⅳ期)表现为髋关节疼痛,部分病例伴髋关节屈曲、内收、外展及内旋功能受限。经保守治疗,4例次症状减轻或消失;16例次症状有所缓解,但Ficat分期无变化;8例次保守治疗无效,行手术治疗。4例次停用激素后发生急性排斥反应,经治疗逆转,并可耐受再次停用激素。结论激素的应用是导致肾移植后股骨头缺血坏死的主要原因;股骨头缺血坏死的治疗效果不佳,因此重在预防。
Objective To investigate the clinical features, diagnosis and treatment of avascular necrosis of the femoral head after renal transplantation. Methods Twenty-four patients with renal allograft received 0.7-7.8 years postoperative avascular necrosis of femoral head, 20 cases of unilateral avascular necrosis of femoral head and 4 cases of bilateral avascular necrosis of the femoral head. According to Ficat staging criteria of femoral head necrosis is divided into 0 ~ Ⅳ period. Twenty-four patients received hormone-containing immunosuppressive regimen after renal transplantation. All patients rapidly reduced the dosage of hormones after the diagnosis of avascular necrosis of femoral head and were discontinued within 2 weeks. Surgical treatment was performed after conservative treatment was ineffective . Results The early stage of onset (stage Ⅰ ~ Ⅱa) showed the pain in front of ipsilateral knee, ipsilateral hip, groin or thigh. The advanced stage Ⅱb ~ Ⅳ showed pain in hip joint. Some cases were accompanied with hip flexion, Income, abduction and internal rotation limited. After conservative treatment, the symptoms in 4 cases were relieved or disappeared. The symptoms of 16 cases were relieved, but the Ficat stage did not change. Eight cases of sub-conservative treatment were ineffective and were treated surgically. Acute rejection occurred 4 times after withdrawal of hormone, after treatment reversal, and can be stopped again hormone. Conclusion The application of hormones is the main cause of avascular necrosis of femoral head after kidney transplantation. The treatment of avascular necrosis of femoral head is not effective and therefore focuses on prevention.