中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (30): 4871-4875.doi: 10.12307/2024.629

• 骨科植入物相关临床实践 Clinical practice of orthopedic implant • 上一篇    下一篇

基于中日友好医院分型ARCO Ⅱ期股骨头坏死的自然塌陷病程

赵汝顺1，2，郝阳泉2，徐韩博1，2，杨  治2，许  鹏2，郑  鑫3，张  堃2，鲁  超2   

  1. 1陕西中医药大学，陕西省咸阳市   712000；2西安交通大学附属红会医院，陕西省西安市   710054；3中南大学湘雅公共卫生学院，湖南省长沙市   410078
  • 收稿日期:2023-08-10 接受日期:2023-09-09 出版日期:2024-10-28 发布日期:2023-12-27
  • 通讯作者: 鲁超，博士，副主任医师，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，陕西中医药大学在读硕士，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:
    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

Natural collapse course of ARCO II stage osteonecrosis of the femoral head based on China-Japan Friendship Hospital classification

Zhao Rushun1, 2, Hao Yangquan2, Xu Hanbo1, 2, Yang Zhi2, Xu Peng2, Zheng Xin3, Zhang Kun2, Lu Chao2   

  1. 1Shaanxi University of Chinese Medicine, Xianyang 712000, Shaanxi Province, China; 2Honghui Hospital Affiliated to Xi’an Jiaotong University, Xi’an 710054, Shaanxi Province, China; 3Xiangya School of Public Health, Central South University, Changsha 410078, Hunan Province, China
  • Received:2023-08-10 Accepted:2023-09-09 Online:2024-10-28 Published:2023-12-27
  • Contact: Lu Chao, MD, Associate chief physician, Honghui Hospital Affiliated to Xi’an Jiaotong University, Xi’an 710054, Shaanxi Province, China
  • About author:Zhao Rushun, Master candidate, Shaanxi University of Chinese Medicine, Xianyang 712000, Shaanxi Province, China; Honghui Hospital Affiliated to Xi’an Jiaotong University, Xi’an 710054, Shaanxi Province, China
  • Supported by:
    Shaanxi Provincial Administration of Traditional Chinese Medicine Integrated Clinical Collaborative Innovation Project, No. 2020-ZXY-010 (to HYQ)

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摘要：


文题释义：

股骨头坏死：是一种骨科常见的难治性疾病，股骨头一旦塌陷，可导致患者髋关节功能障碍，严重影响生活质量。
CJFH分型：是中日友好医院李子荣教授根据股骨头坏死病灶内、中、外侧柱划分的一种分型，可较好地指导应用于临床。


背景：股骨头坏死是骨科难治性疾病之一，不同分期、分型下的股骨头坏死自然塌陷病程影响着该病的进展及预后。

目的：探究不同中日友好医院(China-Japan Friendship Hospital，CJFH)分型下国际骨循环研究协会(Association Research Circulation Osseous，ARCO)Ⅱ期股骨头坏死未塌陷患者5年内自然塌陷病程，并分析不同CJFH分型的股骨头塌陷率及塌陷风险。
方法：回顾性选取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为ARCOⅡ期股骨头坏死未塌陷的患者为研究对象，根据是否塌陷将患髋分为塌陷组(n=82)和未塌陷组(n=70)，统计不同CJFH分型的股骨头塌陷风险以及5年内塌陷时间、塌陷数量和塌陷率，并绘制不同CJFH分型股骨头的Kaplan-Meier生存曲线图。

结果与结论：①共纳入患者97例，152髋，随访期间有82髋塌陷，总塌陷率为53.9%，其中M型、C型、L1型、L2型和L3型塌陷率分别为0.0%，36.7%，51.4%，72.2%和77.8%，各组间比较差异有显著性意义(P < 0.05)；②在塌陷风险方面，L1型塌陷风险为C型的1.704倍(P > 0.05)，而L2型、L3型塌陷风险分别为C型的3.866倍、6.423倍(P < 0.05)；③在Kaplan-Meier生存曲线方面，ARCOⅡ期患者股骨头中位生存时间为3年，95%置信区间为2.885-3.471年，第1，3，5年股骨头生存率分别为65.1%(99/152)，50.7%(77/152)，46.1%(70/152)；④结果表明，不同CJFH分型影响着ARCOⅡ期股骨头坏死患者的塌陷率，其中L3型患者塌陷率最高，L2型和L1型患者次之，C型患者塌陷率较低，M型患者无塌陷，这表明股骨头外侧柱的保留对股骨头坏死自然塌陷病程有重要意义。

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: 股骨头坏死, 塌陷, CJFH分型, ARCO分期, 外侧柱

Abstract: BACKGROUND: Osteonecrosis of the femoral head is one of the refractory diseases in orthopedic diseases. The natural collapse course of osteonecrosis of the femoral head under different stages and types affects the progression and prognosis of the disease.  
OBJECTIVE: To explore the progression of natural collapse within 5 years in patients under the different classifications of China-Japan Friendship Hospital (CJFH) with stage II osteonecrosis of the International Association for Research Circulation Osseous (ARCO), and to analyze the collapse rate and collapse risk of the femoral head under the different classifications of CJFH. 
METHODS: A retrospective study was performed to select patients diagnosed with ARCO II stage osteonecrosis of the femoral head without collapse in the Honghui Hospital Affiliated to Xi’an Jiaotong University from October 2016 to October 2017. According to whether it collapsed, the number of hips was divided into the collapse group (n=82) and the non-collapsed group (n=70). The collapse risk of patients with osteonecrosis of the femoral head under different CJFH classifications, as well as the collapse time, number of collapses, and collapse rate within 5 years were counted, and then the Kaplan-Meier survival curve of the femoral head under different classification of CJFH was plotted.   
RESULTS AND CONCLUSION: (1) A total of 97 patients with 152 hips were enrolled, and 82 hips collapsed during the follow-up period, with a total collapse rate of 53.9%, of which the collapse rates of M type, C type, L1 type, L2 type, and L3 type were 0.0%, 36.7%, 51.4%, 72.2%, and 77.8%, respectively, and the comparison between the groups was statistically significant (P < 0.05). (2) In terms of collapse risk, the collapse risk of L1 type was 1.704 times that of C-type (P > 0.05), while the collapse risks of L2 type and L3 type were 3.866 times and 6.423 times that of C type (P < 0.05), respectively. (3) In terms of the Kaplan-Meier survival curve, the median survival time of the femoral head of ARCO II stage patients was 3 years, with a 95% confidence interval of 2.885-3.471 years, and the survival rates of the femoral head at the first, third and fifth years were 65.1% (99/152), 50.7% (77/152), and 46.1% (70/152), respectively. (4) These findings conclude that different CJFH classifications affect the collapse rate of ARCO II stage osteonecrosis of the femoral head patients, among which L3 type patients have the highest collapse rate, followed by L2 type and L1 type patients; C type patients have a lower collapse rate, and M type patients do not collapse, which indicates that the preservation of the lateral column of the femoral head is of great significance for the natural collapse course of osteonecrosis of the femoral head.

Key words: osteonecrosis of the femoral head, collapse, CJFH classification, ARCO stage, lateral column

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