基于CT坏死区重建的股骨头坏死侧位分型及其临床验证  

A novel lateral classification of osteonecrosis of femoral head based on CT reconstruction of necrotic area and its clinical verification

作　　者：何敏聪 何晓铭 林天烨 肖欢 何伟 魏秋实 HE Mincong;HE Xiaoming;LIN Tianye;XIAO Huan;HE Wei;WEI Qiushi(Joint Center,Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,Guangzhou Guangdong,510378,P.R.China;Guangdong Academy of Traditional Chinese Medicine Orthopedics and Traumatology,Guangzhou Guangdong,510378,P.R.China;Department of Orthopedics,Bijie Hospital of Traditional Chinese Medicine,Bijie Guizhou,551700,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]毕节市中医院骨伤科,贵州毕节551700

出　　处：《中国修复重建外科杂志》2023年第4期423-430,共8页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(82274544、81873327、82004392);2022年毕节市科学技术局2022年度“揭榜挂帅”项目(毕科合重大专项[2022]1号);广州中医药大学“双一流”与高水平大学学科协同创新团队重大项目/培育项目(2021XK05、2021XK41);2021年广东省中医骨伤研究院开放课题重点项目(GYH202101-01、GYH202101-04)。

摘　　要：目的分析股骨头坏死(osteonecrosis of the femoral head,ONFH)不同日本厚生省骨坏死研究会(JIC)分型的股骨头塌陷与手术情况,总结各分型ONFH的预后规律,并对C1型探索基于CT坏死区重建的ONFH侧位分型的临床意义并验证其临床作用。方法以2004年5月—2016年12月收治的119例(155髋)ONFH患者为研究对象,JIC分型:A型34髋,B型33髋,C1型57髋,C2型31髋。各JIC分型患者的年龄、性别、侧别、ONFH类型差异均无统计学意义(P>0.05)。分析不同JIC分型的1、2、5年股骨头塌陷及手术情况,以及不同JIC分型、激素性/非激素性ONFH、无症状与有症状(疼痛时间>6个月或≤6个月)髋关节间及联合保留角(combined preserved angle,CPA)≥118.725°和CPA<118.725°髋关节间的生存率(以股骨头塌陷为终点)。选取组内手术及塌陷发生差异较大、具备研究价值的JIC C1分型,根据其坏死区在股骨头表面的位置,在CT重建侧位将其分成5个亚型,并提取坏死区轮廓线,匹配至标准股骨头模型上,对5个亚型的坏死情况进行热力图图像呈现。分析不同侧位亚型1、2、5年的股骨头塌陷和手术情况,并比较该型患者中CPA≥118.725°和CPA<118.725°髋关节间的生存率(以股骨头塌陷为终点),以及不同侧位亚型的生存率(分别以股骨头塌陷和手术为终点)。结果JIC C2型患髋1、2、5年股骨头塌陷率与手术率均明显高于其他分型(P<0.05);而C1型患髋塌陷率与手术率均高于A、B型(P<0.05)。不同JIC分型患髋的生存率差异有统计学意义(P<0.05),A、B、C1、C2型逐渐降低;无症状髋关节生存率明显高于有症状髋关节,CPA≥118.725°的髋关节生存率明显高于CPA<118.725°的髋关节,差异均有统计学意义(P<0.05)。对C1型髋关节坏死区域CT重建侧位进行进一步分型,1型12髋、2型20髋、3型9髋、4型9髋、5型7髋。随访5年时各亚型之间股骨头塌陷率及手术率比较差异均有统计学意义(P<0.05)。4、Objective To analyze the femoral head collapse and the operation of osteonecrosis of the femoral head(ONFH)in different Japanese Investigation Commitee(JIC)types,in order to summarize the prognostic rules of each type of ONFH,and explore the clinical significance of CT lateral subtypes based on reconstruction of necrotic area of C1 type and verify their clinical effect.Methods A total of 119 patients(155 hips)with ONFH between May 2004 and December 2016 were enrolled in the study.The total hips consisted of34 hips in type A,33 in type B,57 in type C1,and 31 in type C2,respectively.There was no significant difference in age,gender,affected side,or type of ONFH of the patients with differenct JIC types(P>0.05).The 1-,2-,and 5-year femoral head collapse and operation of different JIC types were analyzed,as wellas the survival rate(with femoral head collapse as the end point)of hip joint between different JIC types,hormonal/non-hormonal ONFH,asymptomatic and symptomatic(pain duration>6 months or≤6 months),and combined preserved angle(CPA)≥118.725°and CPA<118.725°.JIC types with significant dfferences in subgroup surgery and collapse and with research value were selected.According to the location of the necrotic area on the surface of the femoral head,the JIC classification was divided into 5 subtypes in the lateral CT reconstruction,and the contour line of the necrotic area was extracted and matched to the standard femoral head model,and the necrosis of the five subtypes was presented by thermography.The 1-,2-,and 5-year outcomes of femoral head collapse and operation in different lateral subtypes were analyzed,and the survival rates(with collapse of the femoral head as the end point)between CPA≥118.7250 and CPA<118.725°hip in patients with this subtype were compared,as well as the survival rates of different lateral subtypes(with collapse and surgery as the end points,respectively).Results The femoral head collapse rate and operation rate in the 1-,2-,and 5-year were significantly higher in patients with JI

关 键 词：股骨头坏死 热力图 日本厚生省骨坏死研究会分型 CT侧位分型 

分 类 号：R687.3[医药卫生—骨科学]