Chinese Journal of Tissue Engineering Research ›› 2019, Vol. 23 ›› Issue (20): 3170-3175.doi: 10.3969/j.issn.2095-4344.1236

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Relationship between bone marrow edema and “survival with collapse” of osteonecrosis of the femoral head assessed by X-ray   

Chen Qunqun1, Zhou Chi2, He Wei2   

  1. 1the Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510378, Guangdong Province, China; 2the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Online:2019-07-18 Published:2019-07-18
  • About author:Chen Qunqun, MD, Attending physician, the Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510378, Guangdong Province, China
  • Supported by:

    the Natural Science Foundation of Guangdong Province, No. 2018A030310606 (to CQQ)| the Research Project of Traditional Chinese Medicine Bureau of Guangdong Province, No. 20161122 (to CQQ)

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Abstract:

BACKGROUND: Bone marrow edema is commonly seen after the collapse of osteonecrosis of the femoral head, which is may be an important imaging index for assessing the “survival with collapse” of osteonecrosis of the femoral head.

OBJECTIVE: To analyze the relationship between the bone marrow edema after the collapse of osteonecrosis of the femoral head and the changes of femoral head imaging, and to explore the significance of bone marrow edema in the treatment of osteonecrosis of the femoral head of “survival with collapse”.
METHODS: The case data were obtained from the Specialist Department of Osteonecrosis of the Femoral Head at the First Affiliated Hospital of Guangzhou University of Chinese Medicine (2012-2016), who recorded in the non-surgical treatment of osteonecrosis of the femoral head in the “Guangdong Provincial Dominant Disease (Osteonecrosis of the Femoral Head) Breakthrough Project”. Sixty cases (81 hips) with collapsed osteonecrosis of the femoral head, 43 males with 61 hips and 17 females with 20 hips, were followed up. The patients were grouped according to the improved bone marrow edema grade: no bone marrow edema (grade 0, 15 hips), mild bone marrow edema (grades 1 and 2, 37 hips), severe bone marrow edema (grade 3, 29 hips). Informed consents were obtained from all patients, and the study was approved by the Ethics Committee of the hospital. All patients were treated with Chinese medicine, and underwent functional exercise. Frog-leg X-ray films of hip joint were examined every 3 months. The collapse, head-acetabulum match and joint stability on frog-leg X-ray films were observed. The influence of bone marrow edema grade on the X-ray changes after the collapse of osteonecrosis of the femoral head was analyzed.
RESULTS AND CONCLUSION: (1) Sixty cases (81 hips) had complete follow-up data. The follow-up time was 4-72 months. (2) By the χ2 test of R*C, different bone marrow edema grades would significantly affect the progress of frog-log X-ray after collapse (collapse, head-acetabulum match, and joint stability) (P < 0.05). (3) In summary, bone marrow edema is widely observed after the collapse of osteonecrosis of the femoral head, and bone marrow edema will fully affect the X-ray changes after collapse. The higher the bone marrow edema grade, the higher the probability of the collapse, head-acetabulum match and joint stability of the frog-leg X-ray films. Bone marrow edema is an important imaging indicator to assess the prognosis of collapse of osteonecrosis of the femoral head.

Key words: osteonecrosis of the femoral head, bone marrow edema, survival with collapse, X-ray, bone marrow edema grade, frog-leg position, collapse, head-acetabulum match, joint stability

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