中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (6): 917-921.doi: 10.12307/2024.010

• 骨科植入物 orthopedic implant • 上一篇    下一篇

不同坏死病灶位置对非创伤性股骨头坏死自然病程的影响

赵汝顺1，2，郝阳泉1，许  鹏1，郑  鑫3，姜永宏1，张玉婷1，王孟飞1，2，鲁  超1   

  1. 1西安交通大学附属红会医院，陕西省西安市   710054；2陕西中医药大学，陕西省咸阳市   712000；3中南大学湘雅公共卫生学院，湖南省长沙市   410078
  • 收稿日期:2022-12-29 接受日期:2023-03-02 出版日期:2024-02-28 发布日期:2023-07-12
  • 通讯作者: 鲁超，医学博士，副主任医师，硕士生导师，西安交通大学附属红会医院，陕西省西安市 710054
  • 作者简介:赵汝顺，男，1995年生，河南省商丘市人，汉族，硕士，主要从事股骨头坏死和骨关节退行性疾病的临床与实验研究。
  • 基金资助:
    中国博士后科学基金资助项目(2017M613179)，项目负责人：鲁超；陕西省中医药管理局中西医结合临床协作创新项目(2020-ZXY-010)，项目负责人：郝阳泉

Effect of different locations of necrotic focus on the natural course of non-traumatic osteonecrosis of the femoral head

Zhao Rushun1, 2, Hao Yangquan1, Xu Peng1, Zheng Xin3, Jiang Yonghong1, Zhang Yuting1, Wang Mengfei1, 2, Lu Chao1   

  1. 1Honghui Hospital Affiliated to Xi’an Jiaotong University, Xi’an 710054, Shaanxi Province, China; 2Shaanxi University of Chinese Medicine, Xianyang 712000, Shaanxi Province, China; 3Xiangya School of Public Health, Central South University, Changsha 410078, Hunan Province, China
  • Received:2022-12-29 Accepted:2023-03-02 Online:2024-02-28 Published:2023-07-12
  • Contact: Lu Chao, MD, Associate chief physician, Master’s supervisor, Honghui Hospital Affiliated to Xi’an Jiaotong University, Xi’an 710054, Shaanxi Province, China
  • About author:Zhao Rushun, Master, Honghui Hospital Affiliated to Xi’an Jiaotong University, Xi’an 710054, Shaanxi Province, China; Shaanxi University of Chinese Medicine, Xianyang 712000, Shaanxi Province, China
  • Supported by:
    the China Postdoctoral Science Foundation, No. 2017M613179 (to LC); Clinical Collaborative Innovation Project of Integrated Traditional Chinese and Western Medicine of Shaanxi Provincial Administration of Traditional Chinese Medicine, No. 2020-ZXY-010 (to HYQ)

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摘要：


文题释义：

非创伤性股骨头坏死：是指没有外力因素的参与，多数由于滥用激素或大量酗酒、自身代谢紊乱等导致的股骨头血液供应受阻、结构改变及塌陷。
股骨头JIC分型：是2001年日本骨坏死调查委员会根据坏死的部位、类型和坏死程度制定的股骨头坏死分型系统，这种分型方法在日本得到广泛应用。


背景：非创伤性股骨头坏死若股骨头发生塌陷将会显著影响患者的正常生活，因此需要使用恰当方式去评估股骨头塌陷风险，进而采取针对性措施延缓股骨头塌陷进程。

目的：分析不同坏死病灶位置下早期股骨头坏死(未塌陷时)的自然病程发展规律。
方法：选择2016年10月至2017年10月在西安交通大学附属红会医院门诊确诊的早期非创伤性股骨头坏死患者121例(191髋)，门诊随访5年后，观察在不同JIC分型下股骨头坏死塌陷情况及各分型之间的股骨头塌陷风险系数，计算随访期间股骨头坏死塌陷率。

结果与结论：①纳入191髋，随访期间股骨头塌陷86髋，股骨头总塌陷率为45.0%；在影响因素里，年龄、ARCO分期、JIC分型为股骨头塌陷的主要影响因素(P < 0.05)，体质量指数值、性别、发病侧别、致病因素不是股骨头塌陷的主要影响因素(P > 0.05)；②纳入的191髋中，随访期间JIC分型A型、B型、C1型、C2型的股骨头总塌陷率分别为11.1%(2/18)，30.2%(16/53)，52.4%(43/82)，65.8%(25/38)，各分型间股骨头总塌陷率比较差异有显著性意义(P < 0.05)；塌陷风险结果显示，B型、C1型、C2型股骨头塌陷风险分别是A型的2.41，5.22，7.89倍；③JIC分型及ARCO分期均与股骨头塌陷具有相关性(P < 0.01)，在ARCOⅠ期患髋中，各JIC分型股骨头塌陷率比较差异无显著性意义(P > 0.05)；在ARCOⅡ期患髋中，JIC A型、B型、C1型及C2型的股骨头塌陷率分别为1.2%，19.5%，50.0%，29.3%，各分型间股骨头塌陷率比较差异有显著性意义(P < 0.05)；④随访期间，第1-5年内的股骨头塌陷率分别为29.3%，7.9%，4.7%，2.6%，0.5%；⑤结果显示，对于早期非创伤性股骨头坏死，1年内股骨头塌陷的风险大，骨坏死病灶位置影响着股骨头塌陷的风险，临床治疗中应考虑到病灶位置对疾病预后的影响。

https://orcid.org/0000-0003-4537-8384 (赵汝顺) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 非创伤性股骨头坏死, 股骨头塌陷, 病灶位置, JIC分型, 自然病程

Abstract: BACKGROUND: For non-traumatic osteonecrosis of the femoral head, if the femoral head collapses, it will have a great impact on the normal life of the patients. Thus, it is necessary to use an appropriate way to evaluate the risk of femoral head collapse and then to take targeted measures to delay the process of femoral head collapse.  
OBJECTIVE: To analyze the natural course of early osteonecrosis of the femoral head (without collapse) under different locations of necrotic lesions.
METHODS: 121 patients (191 hips) with early non-traumatic osteonecrosis of the femoral head who were treated in the Outpatient Department of Honghui Hospital Affiliated to Xi’an Jiaotong University from October 2016 to October 2017 were enrolled in this study. The clinical data of all patients were followed up for 5 years to observe the collapse of osteonecrosis of the femoral head and the risk coefficient of femoral head collapse among different JIC types. The collapse rate of osteonecrosis of the femoral head was calculated during the follow-up.  
RESULTS AND CONCLUSION: (1) A total of 191 hips were included in this study. The femoral head collapsed in 86 hips during follow-up, with a total collapse rate of 45.0%. Among the influencing factors, age, ARCO stage and JIC classification were the main influencing factors of femoral head collapse (P < 0.05), but body mass index, sex, incidence side and pathogenic factors were not the main influencing factors (P > 0.05). (2) Among 191 hips, in JIC classification, the total collapse rates of type A, type B, type C1 and type C2 were 11.1%(2/18), 30.2%(16/53), 52.4%(43/82), and 65.8%(25/38), respectively. There were significant differences in the total collapse rate of the femoral head among all types (P < 0.05). The collapse risk results showed that the collapse risk of type B, type C1 and type C2 was 2.41, 5.22 and 7.89 times higher than that of type A, respectively. (3) Both JIC classification and ARCO stage were correlated with femoral head collapse (P < 0.01). There was no significant difference in the collapse rate of the femoral head among all JIC types in ARCO I stage hips (P > 0.05). In the hips with ARCO II stage, the collapse rates of the femoral head of JIC types A, B, C1 and C2 were 1.2%, 19.5%, 50.0% and 29.3%, respectively, and there were significant differences in the collapse rates among different types (P < 0.05). (4) During follow-up, the collapse rates of the femoral head in the first to fifth years were 29.3%, 7.9%, 4.7%, 2.6% and 0.5%, respectively. (5) Results showed that for early non-traumatic osteonecrosis of the femoral head, the risk of collapse of osteonecrosis of the femoral head is high within one year, and the location of the focus of osteonecrosis affects the risk of collapse of the femoral head. The effect of the location of the focus on the prognosis of the disease should be considered in clinical treatment.

Key words: non-traumatic osteonecrosis of the femoral head, femoral head collapse, focus location, JIC classification, natural course

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