股骨头坏死病灶分布规律探讨  

Analysis of the lesion distribution in necrosis of the femoral head

作　　者：鲁超[1] 刘洪智[2] 刘道兵[1] 张兵[1] 陈卫衡[1] 

机构地区：[1]中国中医科学院望京医院,北京100102 [2]山东省潍坊市中医院,261041

出　　处：《中国矫形外科杂志》2014年第5期396-400,共5页Orthopedic Journal of China

基　　金："十一五"国家科技支撑计划项目(编号:2007BAI20B035)

摘　　要：[目的]分析股骨头坏死病灶分布状况,为股骨头坏死的治疗方法选择及预后估计提供依据。[方法]收集股骨头坏死的患者104例(167髋),选取其MRI中T1加权冠状面和横断面的影像,通过设定显露股骨头颈最为完整的层面为正中位,将其标记为第0层(Layer 0,L0);正中位之前的层面,由后向前分别依次标记为第1、2、3、4、…层(L1、L2、L3、L4、…);正中位之后的层面,由前向后分别依次标记为第-1、-2、-3、-4、…层(L-1、L-2、L-3、L-4、…),按照设定的标记方法,由前向后将各层进行诊断和标识,统计、分析坏死病灶的分布状况。[结果]在冠状面上,L5、L4、L3、L2、L1、L0、L-1、L-2、L-3各层坏死的发生髋数分别为18髋(10.78%)、52髋(31.34%)、144髋(86.23%)、160髋(95.81%)、161髋(96.41%)、154髋(92.22%)、111髋(66.47%)、55髋(32.93%)、8髋(4.80%),根据坏死的发生频率由高至低分别为L1、L2、L0、L3、L-1、L-2、L4、L5及L-3。在横断面上,L4、L3、L2、L1、L0、L-1、L-2各层坏死的发生髋数分别为12髋(7.19%)、76髋(45.51%)、149髋(89.22%)、150髋(89.83%)、123髋(73.65%)、45髋(26.95%)、8髋(4.80%),根据坏死的发生频率由高至低分别为L1、L2、L0、L3、L-1、L4及L-2。不同因素相关性分析显示,骨坏死病灶好发层面不因性别、年龄、发病侧别的不同而变化。[结论]冠状面上坏死病灶主要集中在L0、L1、L2、L3上,横断面上则主要集中在L0、L1、L2上,两个切面中,L1层面的坏死频率最大,其他层面则以L1层面为中心呈递减趋势。[ Objective] To analyze the lesion distribution in osteonecrosis of the femoral head （ONFH） to enhance the treatment and prognosis of ONFH. [ Methods] One hundred and four cases （167 hips） with ONFH were collected and magnetic resonance （MR） T1 -weighted coronal and cross section images were examined. The layer that completely exposed the femoral head and neck was designated as the median layer and was marked as Layer 0 （IX）） . The layers before the median layer were designated as Layer 1, 2, 3, 4, and so on （ L1, L2, L3, L4…） and the layers after were marked as Layer - 1, - 2, - 3, - 4, and so on （ L - 1, L - 2, L - 3, L4…） . We diagnosed each layer and analyzed the distribution of lesions among the layers. [ Results ] In the coronal section, the number of hips with osteonecrosis in the L5 through L- 3 layers, respectively, was 18 （10.78%）, 52 （31.34%）, 144 （86.23%）, 160 （95.81%）, 161 （96.41%）, 154 （92.22%）, 111 （66.47%）, 55 （32. 93% ） , and 8 （4. 80% ） . Osteoneerosis occurred at the highest frequency at L1 followed by L2, L0, L3, L - l, L -2, L4, LS, and L-3. In the cross section, the numbers of hips in the L4 through L-2 layers, respectively, was 12 （7. 19% ）, 76 （45.51%）, 149 （89.22%）, 150 （89. 83% ）, 123 （73.65%）, 45 （26. 95% ）, and 8 （4. 80% ）, with the highest occur- rence in Ll, followed by L2, L0, L3, L - 1, IA, and L - 2. Correlation analysis showed that the lesions distribution, as characterized by MRI, was unrelated to sex, age, and side. [ Conclusionl Lesions mainly occurred at L0, L1, L2, and L3 in the coronal section and at L0, L1, and L2 in the cross section. Between the two sections, the maximum frequency of necrosis occurred at L1, with the surrounding layers demonstrating less necrosis occurrence.

关 键 词：股骨头坏死 病灶 分布规律 MRI 

分 类 号：R681.8[医药卫生—骨科学]