围塌陷期股骨头坏死不同影像学表现研究  

Clinical significance of different imaging manifestations of osteonecrosis of femoral head in the peri-collapse stage

作　　者：魏秋实 何伟 张庆文 陈镇秋[3] 郑越生 林天烨 WEI Qiushi;HE Wei;ZHANG Qingwen;CHEN Zhenqiu;ZHENG Yuesheng;LIN Tianye(Joint Center,Third Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou Guangdong,510378,P.R.China;Guangdong Academy of Traditional Chinese Medicine Orthopedics and Traumatology,Guangzhou Guangdong,510378,P.R.China;No.3 Department of Orthopectics,the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou Guangdong,510405,P.R.China;Department of Orthopectics,Jinshazhou Hospital,Guangzhou University of Chinese Medicine,Guangzhou Guangdong,510168,P.R.China)

机构地区：[1]广州中医药大学第三附属医院关节中心,广州510378 [2]广东省中医骨伤研究院,广州510378 [3]广州中医药大学第一附属医院三骨科,广州510405 [4]广州中医药大学金沙洲医院骨科,广州510168

出　　处：《中国修复重建外科杂志》2021年第9期1105-1110,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金面上项目(81873327、81573996)。

摘　　要：目的探讨围塌陷期股骨头坏死(osteonecrosis of the femoral head,ONFH)的影像学表现及与疼痛发生的相关性。方法以2016年12月—2019年10月收治且符合选择标准的372例(624髋)围塌陷期ONFH患者作为研究对象。其中男270例,女102例;年龄15~65岁,平均35.3岁。单髋120例,双髋252例。ONFH类型:创伤性39例(39髋)、激素性196例(346髋)、酒精性102例(178髋)、特发性35例(61髋)。其中,有疼痛症状482髋,疼痛时间≤3个月212髋、3~6个月124髋、6~12个月117髋、>12个月29髋;无疼痛142髋。国际骨循环协会(ARCO)分期:Ⅱ期325髋、Ⅲ期299髋。将患者根据ONFH病因以及ARCO分期进行分组,比较髋关节疼痛以及X线片(新月征和囊性改变)、CT(软骨下骨骨折和囊性改变)及MRI(骨髓水肿、关节积液和软骨下低信号带)的影像学表现差异。采用χ2检验分析ONFH疼痛时间与X线片、CT及MRI影像学表现的相关性。结果不同病因ONFH患者在X线片新月征、CT软骨下骨骨折及MRI关节积液方面,差异有统计学意义(P<0.05);不同ARCO分期ONFH患者在髋关节疼痛症状及所有影像学表现方面,差异均有统计学意义(P<0.05)。相关性分析显示ONFH患者疼痛时间与所有影像学表现均相关(P<0.05);同时CT囊性改变与MRI软骨下低信号带、关节积液分级,以及MRI软骨下低信号带与关节积液分级亦相关(P<0.05)。结论围塌陷期ONFH患者影像学上囊性改变、软骨下低信号带、关节积液与股骨头塌陷和髋部疼痛关系密切,当ARCOⅡ期ONFH出现上述信号提示股骨头不稳定,为预判ONFH疾病发展及合理选择保髋治疗方法提供了依据。Objective To explore the different imaging manifestations of osteonecrosis of the femoral head(ONFH)and their correlation with the occurrence of pain during the peri-collapse period.Methods The 372 patients(624 hips)with ONFH in the peri-collapse stage who were admitted between December 2016 and October 2019 and met the selection criteria were selected as the research objects.Among them,there were 270 males and 102 females,with an average age of 35.3 years(mean,15-65 years).There were 120 cases of unilateral hip and 252 cases of bilateral hips.There were 39 cases(39 hips)of traumatic ONFH,196 cases(346 hips)of hormonal ONFH,102 cases(178 hips)of alcoholic ONFH,and 35 cases(61 hips)of idiopathic ONFH.Among them,there were 482 hips with pain symptoms and 142 hips without pain.The pain duration was less than 3 months in 212 hips,3-6 months in 124 hips,6-12 months in 117 hips,and more than 12 months in 29 hips.According to the Association Research Circulation Osseous(ARCO)staging,the ONFH was rated as stageⅡin 325 hips and stageⅢin 299 hips.The patients were grouped according to ONFH etiology and ARCO staging,and hip joint pain and X-ray film(crescent sign and cystic changes),CT(subchondral bone fractures and cystic changes),and MRI(bone marrow edema,joint effusion,and subchondral hypointensity zone)were compared.Spearman rank correlation was used to determine the correlation between ONFH pain duration and X-ray film,CT,and MRI imaging manifestations.Results There were significant differences(P<0.05)between ONFH patients with different etiologies in crescent sign on X-ray film,subchondral bone fracture on CT,and joint effusion on MRI.And there were significant differences(P<0.05)between ONFH patients with different ARCO stages in hip pain duration and all imaging manifestations.Correlation analysis showed that the pain duration of ONFH patients was correlated with all imaging manifestations(P<0.05).The cystic change on CT was correlated with the subchondral hypointensity zone and joint effusion grade on MRI,and s

关 键 词：股骨头坏死 围塌陷期 影像学 临床意义 

分 类 号：R681.8[医药卫生—骨科学]