当科における非外傷性上腕骨頭壊死について

抄録

The avascular necrosis of the humeral head is less common than the femoral head necrosis. The objectives of this study are to examine the clinical and radiological features of the avascular necrosis of the humeral head and to define the relation ship to the femoral head necrosis.
Eighty-five patients, who were diagnosed the femoral or humeral head necrosis, were examined.
The average age of the patients was 43.2 years, ranging from 18 to 79 years. The femoral and humeral head were affected indivisually in seve n ty-four and two patients, respectively. Nine patients were affected both heads. Five patients of these humeral head necrosis (8 shoulders) had corticosteroid therapy and four patients (8 shoulders) had been taking excessive alcohol. In the other two patients (2 shoulders), the pathogenic factor was unknown. Six patients (8 shoulders) of these eleven patients complained pain and eight patients (13 shoulders) had limited shoulder motion. According to the report of the Medical Research Council (1966), eighteen shoulders and the affected hips were classified radiographically, as group I (normal articular surface), group II (deformed articular surface) and group III (osteoarthritis). In the eighteen shoulders of the humeral head necrosis,37.5 % of group I had clinical symptoms. In the eighty-three hips of the femoral head necrosis,77.4 % of group I had severe pain and/or limited motion of the hip joint.
The 22 % of the patients with the femoral head necrosis, which area was involved 50 % or more, were simultaneously showed humeral head necrosis. However, no humeral head necrosis was found in the patients with the femoral head necrosis which area was 50 % or less.
The avascular necrosis of the humeral head is asymptomatic in the early stage and tend to be overlooked. Therefore, in the cases of the femoral head necrosis with the large necrotic area, the careful examinations should be performed on the shoulder and the other joints.