摘要目的:探讨分析影响非创伤性股骨头坏死(Osteonecrosis of the femoral head,ONFH)塌陷的危险因素,评估其预测ONFH塌陷的临床应用价值。方法:收集经影像学检查诊断为早期ONFH(ARCOⅠ、Ⅱ)的患者共计112例(152髋),对以上患者进行随访观察。利用X线图像观察股骨头的塌陷情况;利用MRI图像观察髋关节的关节腔积液、骨髓腔水肿、坏死区信号特点、坏死部位及坏死形态等指标,并测量股骨头坏死体积,计算其坏死体积百分比。对分类变量采用卡方检验;对计量资料采用独立样本T检验。对有统计学意义的影像学指标采用Logistic回归分析其危险因素。结果:112例(152髋)患者发生股骨头塌陷者62髋,未塌陷者90髋。除塌陷组与未塌陷组间性别(P=0.078)、年龄(P=0.631)、病因(P=0.604)和坏死信号比较(P=0.071)之外,其他各项指标均有显著的统计学意义。塌陷组及未塌陷组总的坏死体积百分比平均值分别为40.1%±20.1%、18.3%±19.8%;除塌陷组与未塌陷组后内下(PIM)象限比较(P=0.143)之外,其他各象限值均具有统计学意义。ARCO分期、坏死形态、骨髓水肿、总坏死体积百分比、前外上(ASL)象限坏死体积百分比、后外上(PSL)象限坏死体积百分比均具有统计学意义(P值<0.05)。结论:MRI检查和测量在ONFH的定量评价和预测塌陷中具有重要的临床价值,但预测股骨头塌陷时亦应综合考虑各种临床因素影响,从而进一步提高预测的准确性。
Abstract:Objective: To investigate the risk factors affecting the collapse of non-traumatic osteonecrosis of femoral head(ONFH). And assess the value of clinical application in predicting the collapse of ONFH. Methods: By the imaging diagnosis of early osteonecrosis(ARCOⅠ, Ⅱ) a total of 112 cases of patients(152 hips) were collected for follow-up observation. All patients underwent initial examination of hip with anteroposterior and frog-position X-ray and MRI scans at the time of diagnosis. To evaluate the collapse of the femoral head at each X-ray examination; observe the hip joint effusion, bone marrow edema, necrosis signal features, location of necrotic lesions and necrotic morphology at the first MRI images, and measure the volume of femoral head necrosis, calculate the percentage of necrosis volume. Nominal data were analyzed with the chi-square test and measurement data were analyzed with independent sample T-test. Logistic regression analysis was used to analyze the risk factors. Results: In 112 cases(152 hips), 62 hips were with femoral head collapse, 90 hips were not. In addition to the difference of sex(P=0.078), age(P=0.631), etiology(P=0.604) and necrotic signal comparison(P=0.071) between the collapse group and non-collapse group, other indicators were statistically significant. The total average of the necrosis volume percentage in the collapse and non-collapse groups were 40.1%±20.1%, 18.3%±19.8%, seperately. In addition to PIM quadrant comparison(P=0.143), the difference between collapse group and non-collapse group was statistically significant. ARCO stage, necrotic morphology, bone marrow edema, and necrosis of the total volume percentage, ASL quadrant necrosis volume percentage, PSL quadrant volume percentage of necrosis were statistically significant(P<0.05). Conclusion: MRI examination and quantitative measurement has important clinical value for evaluation and prediction of the collapse of femoral head, but various factors should be taken into account for predicting collapse of the femoral head, thus improving the accuracy of predictions.