股骨头坏死ARCO 3A期平片分期准确性及误分期原因分析  

Analysis of Accuracy and Reasons for Misstaging of ARCO 3A of Femoral Head Necrosis by Radiography

作　　者：史珊[1] 佟海滨[1] 杨学东[1] 范洋洋[1] 刘欢[1] 张阔 马云瑶[1] 于潼[3] SHI Shan;TONG Hai-bin;YANG Xue-dong;FAN Yang-yang;LIU Huan;ZHANG Kuo;MA Yun-yao;YU Tong(Department of Radiology,Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China;Department of Policlinic,Peking University First Hospital,Beijing 102627,China;Department of Orthopaedics,Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China)

机构地区：[1]中国中医科学院广安门医院放射科,北京100053 [2]北京大学第一医院门诊部,北京102627 [3]中国中医科学院广安门医院骨科,北京100053

出　　处：《中国CT和MRI杂志》2024年第4期151-153,共3页Chinese Journal of CT and MRI

基　　金：北京联影智能影像技术研究院基金(CRIBJQY202109);中国中医科学院科技创新工程项目(CI2021A03302、CI2021A03320);中国中医科学院广安门医院护航工程-骨干人才培育项目(9323015)。

摘　　要：目的评估X线平片对股骨头坏死ARCO3A期分期的准确性,并分析其误分期的原因。方法回顾性分析2017年1月至2023年7月同期行髋关节正、蛙式位X线及CT检查,且髋关节CT分期为ARCO3A期的158例股骨头坏死患者,其中14例为双侧ARCO3A期,共计172例ARCO3A期股骨头坏死,F/M=67/91,平均年龄43.7±11.8岁。观察髋关节X线正、蛙式位图像进行ARCO分期并统计结果。结果髋关节X线分期为ARCO 3A期139例,误分期为ARCO 2期33例,准确率为80.8%;对照同期髋关节CT图像,X线误分期病例中未发现软骨下骨折6例(18.2%)、未发现坏死区骨折4例(12.1%)、未发现股骨头局限塌陷23例(69.7%)。结论X线对股骨头坏死ARCO 3A期分期的准确性高,但仍存在误分期的状况。在临床工作中,正位结合蛙式位,仔细观察关节面局部轻微不光整及软骨下、坏死区骨折等征象有助于提高X线平片对股骨头坏死ARCO3A期分期的准确性。Objective To evaluate the accuracy of radiography for ARCO stage 3A of femoral head necrosis(FHN)and to analyze the reasons for its misstaging.Methods 158 patients of FHN,who underwent anteroposterior view and frog lateral view of X-ray and CT examinations of hip joint during the same period,staged as ARCO 3A by CT from January 2017 to July 2023 were retrospectively analyzed,of which 14 patients with bilateral ARCO stage 3A,so a total of 172 cases(F/M=67/91,average age:43.7±11.8 years)were included.The anteroposterior view and frog lateral view of X-ray standard radiographs of hip joint were observed for ARCO staging and statistics.Results There were 139 cases staged as ARCO 3A,and 33 cases misstaged as ARCO 2 evaluated by radiography,and the accuracy was 80.8%.Referring to hip CT images of the same period,in the cases of radiography misstaging,6 cases(18.2%)of subchondral fractures,4 cases(12.1%)of necrotic area fractures,and 23 cases(69.7%)of femoral head local collapse were not found.Conclusion The accuracy of radiography for ARCO stage 3A of FHN is high,but there is still some misstaging.In clinical work,anteroposterior view combined with frog lateral view,careful observation and identification of local slight collapse of articular surface and subchondral and necrotic area fractures is helpful to improve the accuracy of radiography for ARCO stage 3A of FHN.

关 键 词：股骨头坏死 ARCO 3A期 X线 CT 分期 

分 类 号：R617[医药卫生—外科学]