CT影像HU值在股骨头坏死减压植骨手术前后的变化及临床意义  

Changes and clinical significance of HU value in CT images before and after decompression and bone grafting for femoral head necrosis

作　　者：陈蛟 郭晓忠 王冉东[1] 孙强 李兵[1] 岳聚安 刘忘言 CHEN Jiao;GUO Xiaozhong;WANG Randong;SUN Qiang;LI Bing;YUE Ju'an;LIU Wangyan(Department of Joint Surgery,Aviation General Hospital,Beijing 100012;Department of Orthopaedic Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]航空总医院骨关节科,北京100012 [2]北京积水潭医院矫形骨科,北京100035

出　　处：《中华骨与关节外科杂志》2022年第6期431-437,共7页Chinese Journal of Bone and Joint Surgery

基　　金：首都医学发展科研基金(2009-3098)

摘　　要：目的:探讨股骨头坏死(ONFH)行髓芯减压植骨术后,股骨头坏死区及邻近区域CT影像HU值的变化及临床意义。方法:回顾性纳入2018年1月至2019年1月行髓芯减压植骨术治疗的国际骨循环研究协会(ARCO)Ⅱ、Ⅲ期ONFH患者24例。采集术前及术后3、6、12个月的髋关节CT影像,设置不同兴趣区(ROI):植骨区与股骨头负重面皮质间松质骨区(ROI-Ⅱ、ROI-Ⅲ)及邻近区(负重区外侧ROI-Ⅰ、负重区内侧ROI-Ⅳ),软件MIMIC 21测量其HU值。比较不同ROI、不同时间点的HU值。结果:(1)术前除ROI-Ⅱ与ROI-Ⅲ之外,其他各ROI的HU值差异均有统计学意义(P均<0.05),同时ROI-Ⅱ和ROI-Ⅲ的HU值高于ROI-Ⅰ和ROI-Ⅳ。(2)ROI-Ⅰ与ROI-Ⅱ和ROI-Ⅲ、ROI-Ⅱ与ROI-Ⅳ、ROI-Ⅲ与ROI-Ⅳ的HU值在术后3、6、12个月的差异均有统计学意义(P均<0.001);ROI-Ⅱ与ROI-Ⅲ的HU值的差异仅在术后12个月有统计学意义(P=0.041);ROI-Ⅰ与ROI-Ⅳ的HU值在术后3、6、12个月的差异均无统计学意义(P均>0.05)。(3)ROI-Ⅰ与ROI-Ⅲ在术前、术后3个月、术后6个月的HU值递增(P均<0.05),但在术后6、12个月的递增差异无统计学意义(P>0.05);ROI-Ⅱ与ROI-Ⅳ在术前、术后3个月、术后6个月、术后12个月的HU值递增(P均<0.05);同时ROI-Ⅱ和ROI-Ⅲ的HU值在术后各时间点均高于ROI-Ⅰ和ROI-Ⅳ。结论:ONFH负重区的骨密度高于非负重区。ONFH行髓芯减压植骨术后,负重区与非负重区的骨密度均增大,且负重区骨密度高于非负重区,说明髓芯减压植骨术能刺激成骨,且不同ROI的成骨能力不同。Objective:To explore the changes and clinical significance of HU value in CT images of femoral head necrosis area and its adjacent area after core decompression and bone grafting.Methods:Totally 24 patients with Association Research Circulation Osseous(ARCO)stageⅡandⅢosteonecrosis of the femoral head(ONFH)who underwent core decompression and bone grafting from January2018 to January 2019 were retrospectively included.CT images of hip joint were collected before and 3,6,and 12 months after operation,and different regions of interest(ROI)were set:cancellous bone area between bone graft and bearing surface of femoral head(ROI-Ⅱ,ROI-Ⅲ)and adjacent areas(ROI-Ⅰlateral to ROI-Ⅱ,ROI-Ⅳmedial to ROI-Ⅲ).The HU value was measured by software MIMIC 21.HU values of different ROI and different time points were compared.Results:(1)Except for ROI-Ⅱand ROI-Ⅲ,the HU values were significantly different before operation(P<0.05),and the HU values of ROI-Ⅱand ROI-Ⅲwere higher than those of ROI-Ⅰand ROI-Ⅳ.(2)The HU values of ROI-Ⅰand ROI-Ⅱand ROI-Ⅲ,ROI-Ⅱand ROI-Ⅳ,ROI-Ⅲand ROI-Ⅳwere significantly different at 3,6 and12 months after operation(P<0.001);The HU values of ROI-Ⅱand ROI-Ⅲhad significant difference only at 12 months after operation(P=0.041);There was no significant difference in HU values between ROI-Ⅰand ROI-Ⅳat 3,6 and 12 months after operation(P>0.05).(3)The HU values of ROI-Ⅰand ROI-Ⅲincreased before operation,3 months and 6 months after operation(P<0.05),but there was no significant difference between them at 6 and 12 months after operation(P>0.05);The HU values of ROI-Ⅱand ROI-Ⅳincreased before operation,3 months,6 months and 12 months after operation(P<0.05);the HU values of ROI-Ⅱand ROI-Ⅲwere higher than those of ROI-Ⅰand ROI-Ⅳat all time-points after operation.Conclusions:The bone mineral density in the weight-bearing area of ONFH is higher than that in the non weight-bearing area.After core decompression and bone grafting,the bone mineral density of both

关 键 词：股骨头坏死 髓芯减压 影像学 CT 

分 类 号：R687.3[医药卫生—骨科学]