股骨头坏死塌陷预测方法的临床意义  

The significance of collapse prediction in clinical assessment of the femoral head necrosis

作　　者：魏秋实[1] 何伟[2] 张庆文[2] 庞智晖[2] 陈镇秋[2] 陈鹏[1] 

机构地区：[1]广州中医药大学第一临床医学院,广州510405 [2]广州中医药大学第一附属医院三骨科,广州510407

出　　处：《广东医学》2011年第19期2523-2526,共4页Guangdong Medical Journal

基　　金：高等学校博士学科点专项科研基金资助项目(编号:20104425120012)

摘　　要：目的探讨塌陷预测方法在股骨头坏死临床评价中的意义。方法选取30例37髋未予系统治疗的股骨头坏死患者,用以对比和评估几种主要塌陷预测方法在股骨头坏死塌陷预测中的价值,从中选择最佳预测法预测塌陷风险和评价保髋治疗的临床疗效。结果改良Kerboul角度测量法、坏死区表面积百分比测量法、坏死区体积百分比测量法预测塌陷准确率分别为62.2%、56.8%、83.8%,Youden's指数分别为0.17、0.045、0.655。正位分型法预测,其中B型没有塌陷;C1、C2型预测准确率分别为为44.4%和94.4%,Youden's指数分别为0和0.94。中心性坏死均未塌陷。结论如果坏死分型属于B型或坏死形态属于中心性坏死,则塌陷风险低;若正位分型属于C2型,则塌陷风险高;若正位分型属于C1型,则同时考虑坏死区体积百分比,若体积百分比>40%,则塌陷风险高。不同塌陷预测方法各有利弊,不能单独使用,应围绕正位分型法进行综合分析,早期诊断是提高中医药保髋疗效的关键。Objective To evaluate the significance of collapse prediction in clinical assessment of femoral head necrosis.Methods Osteonecrosis of femoral head（ONFH） in 37 hips of 30 patients,who received no systemic treatment of ONFH,were assessed with several major collapse prediction methods.Results Prediction accuracy rates of collapse with Modified Kerboul method,necrotic zone projective surface area ratio and necrotic zone volume ratio were 62.2%,56.8% and 83.8%,respectively;while Youden′s indexes were 0.17,0.045,0.655,respectively.In the anteroposterior typing,no type B collapse was revealed;while type C1 and C2 prediction accuracy was 44.4% and 94.4%,respectively,with Youden′s indexes of 0 and 0.9.Conclusion Conservative treatment can be applied in patients with type B or central necrosis,which suggests low collapse risk;while surgical treatment should be applied in type C2 necrosis,which suggests high risk of collapse is high.However,surgical treatment is considered in type C1 necrosis with necrosis volume percentage over 40%.Each prediction method has its advantages and disadvantages and can not used alone.Comprehensive analysis should base on orthotopic typing for decision.Early diagnosis is crucial for improvement of the efficacy of Chinese medicine on hip preserviation.

关 键 词：塌陷预测 股骨头坏死 股骨头 

分 类 号：R681[医药卫生—骨科学]