MRI评估ARCO不同分期内单侧股骨头缺血坏死髋关节双侧坐骨股骨间隙的变化  

Comparative analysis of bilateral ischiofemoral space in patients with unilateral femoral head necrosis in different ARCO stages by MRI

作　　者：宋彦芳 张泽坤 桑辉[1] 王勇[1] 贾丽英[1] 张欲翔 SONG Yanfang;ZHANG Zekun;SANG Hui;WANG Yong;JIA Liying;ZHANG Yuxiang(Department of Radiology,the TCM Hospital of Hebei Province,Shijiazhuang 050011,China)

机构地区：[1]河北省中医院放射科,石家庄050011

出　　处：《磁共振成像》2021年第4期65-68,共4页Chinese Journal of Magnetic Resonance Imaging

基　　金：河北省中医药管理局科研计划(编号:2019068)。

摘　　要：目的分析ARCO不同分期内单侧股骨头缺血坏死(osteonecrosis of the femoral head,ONFH)患者双侧坐骨股骨间隙(ischiofemoral space,IFS)的变化情况。材料与方法回顾性分析57例单侧ONFH患者(试验组)、25例健康志愿者(对照组)的双侧髋关节MRI图像,按照ARCO标准将单侧ONFH患者进行分期,测量所有髋关节的IFS、股方肌间隙(quadratus femoris space,QFS)和颈干角(cervicodiaphyseal angle,CCD)。应用Kruskal-Wallis one-way test检验检测对照组髋关节、试验组股骨头坏死侧髋关节及试验组正常侧髋关节IFS、QFS、CCD的差别,应用配对t检验检测试验组内双侧髋关节间IFS、QFS、CCD的差别。结果试验组正常侧IFS[(21.16±7.09)mm]、QFS[(12.36±6.82)mm]小于对照组[IFS:(26.04±6.15)mm,QFS:(20.01±7.09)mm]及试验组坏死侧[IFS:(25.18±5.50)mm,QFS:(19.52±5.31)mm],试验组正常侧CCD[(137.74±3.88)°]大于对照组[(131.02±5.01)°]及试验组坏死侧[(132.40±7.05)°],差异均有统计学意义;试验组坏死侧IFS、QFS及CCD与对照组均无差别。57例单侧ONFH患者中ARCOⅠ期10例、Ⅱ期17例、Ⅲ期18例、Ⅳ期12例。ARCOⅠ、Ⅱ期的股骨头正常侧IFS[(17.49±6.33)mm(Ⅰ期)、(24.24±7.29)mm(Ⅱ期)]、QFS[(12.46±6.42)mm(Ⅰ期)、(14.93±6.78)mm(Ⅱ期)]、CCD[(134.56±6.06)°(Ⅰ期)、(131.94±9.08)°(Ⅱ期)]与坏死侧[(Ⅰ期IFS:(22.34±5.31)mm,QFS:(16.04±5.21)mm,CCD:(135.16±7.62)°;Ⅱ期IFS:(25.32±7.25)mm,QFS:(19.64±5.29)mm,CCD:(132.06±5.88)°]均无差别;而ARCOⅢ期的股骨头正常侧IFS[(19.76±7.97)mm]、QFS[(14.93±6.78)mm]均小于坏死侧IFS[(24.47±6.26)mm]、QFS[(19.64±5.29)mm],正常侧CCD[(135.76±5.70)°]大于坏死侧[(129.64±2.42)°];ARCOⅣ期的股骨头正常侧IFS[(23.17±6.86)mm]、QFS[(17.11±7.33)mm]亦均小于坏死侧IFS[(28.57±5.23)mm]、QFS[(22.88±6.24)mm],正常侧CCD[(137.63±7.62)°]大于坏死侧[(132.76±6.05)°]。结论单侧ARCOⅢ、Ⅳ期ONFH患者的正常侧髋关节IFS和QFS会减小,其并发坐骨股骨撞Objective:To investigate the changes of ischiofemoral space of bilateral hip joints in patients with unilateral osteonecrosis of the femoral head(ONFH)in different ARCO stages.Materials and Methods:All the bilateral hip joints MR images of 57 patients with unilateral ONFH(experimental group)and 25 voulanters(control group)were retrospectively analyzed.Staging all ONFH patients according to ARCO standards.The ischiofemoral space(IFS),quadratus femoris space(QFS)and cervico diaphyseal angle(CCD)of all hip joints were measured on MRI.The difference of IFS,QFS and CCD between control group,normal joints of experimental group and necrotic joints of experimental group were compared by Kruskal-Wallis one-way test,the difference of IFS,QFS and CCD between bilateral hip joints in each ARCO stage of experimental group were compared by paired t test respectively.Results:IFS[(21.16±7.09)mm],QFS[(12.36±6.82)mm]of normal side in the experimental group was smaller than those of the control group[IFS:(26.04±6.15)mm,QFS:(20.01±7.09)mm]and the necrotic side[IFS:(25.18±5.50)mm,QFS:(19.52±5.31)mm],CCD[(137.74±3.88)°]of normal side in the experimental group was bigger than those of the control group(131.02±5.01)°and the necrotic side[(132.40±7.05)°],the difference was statistically significant;there was no difference of IFS,QFS and CCD between necrostic hip in experimental group and control group.Of57 patients with unilateral ONFH,10 were in ARCOⅠ17 inⅡ,18 inⅢand 12 inⅣ.In ARCOⅢandⅣ,IFS[Ⅲ(19.76±7.97)mm,Ⅳ(23.17±6.86)mm]and QFS[Ⅲ(14.93±6.78)mm,Ⅳ(17.11±7.33)mm]of normal hip joint were smaller than those of necrotic hip joint[IFSⅢ(24.47±6.26)mm,Ⅳ(28.57±5.23)mm,QFSⅢ(19.64±5.29)mm,Ⅳ(22.88±6.24)mm],P<0.05;CCD[Ⅲ(135.76±5.70)°,Ⅳ(137.63±7.62)°]of normal hip joint were bigger than those of necrotic hip joint[CCDⅢ(129.64±2.42)°,Ⅳ(132.76±6.05)°],P<0.05.In ARCOⅠandⅡ,IFS[Ⅰ(17.49±6.33)mm,Ⅱ(24.24±7.29)mm],QFS[Ⅰ(12.46±6.42)mm,Ⅱ(14.93±6.78)mm]and CCD[Ⅰ(134.56±6.06)°,Ⅱ

关 键 词：股骨头缺血坏死 ARCO分期 坐骨股骨间隙 股方肌间隙 股骨颈干角 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R681.6[医药卫生—诊断学]