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Corticosteroid-associated avascular necrosis: dose relationships and early diagnosis

机译:皮质类固醇相关的养血性坏死:剂量关系和早期诊断

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摘要

Corticosteroids are the most common etiological factor in nontraumatic avascular necrosis (AVN) of bone, ac-counting for about 10% of arthroplasties performed annually in the United States. Evidence is conflicting on the relative importance of peak dose, daily dose, or cumulative dose, and most likely all three represent "high dose" corticosteroid administration and play a role in AVN. The etiology may be multifactorial with corticosteroids superimposed on genetic or pathological predispositions. Joint preservation depends upon early diagnosis and treatment before fracture of the subchondral trabeculae and joint incongruity. Early intervention depends upon identifying at-risk patients and quantifying their risk by understanding clinical and pathophysiological contri-butions to that risk. Our data and that of others suggest that a screening MRI of at-risk populations will permit detection of AVN at a prefracture stage when preservation of the joint is possible.
机译:皮质类固醇是骨的非创伤性缺血坏死(AVN)中最常见的病因因素,AC计数约10%的关节塑料在美国进行。证据与峰剂量,每日剂量或累积剂量的相对重要性相互矛盾,并且很可能所有三种代表“高剂量”皮质类固醇给药,并在AVN中发挥作用。病因可以是具有叠加在遗传或病理易感性的皮质类固醇的多重术。联合保存取决于骨折小梁骨折前的早期诊断和治疗和关节不协调。早期干预取决于鉴定风险患者,并通过了解临床和病理生理对抗对此风险来量化其风险。我们的数据和其他数据表明,风险风险群体的筛选MRI将允许在可以保存关节的预制阶段检测AVN。

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