中国组织工程研究

中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (9): 1890-1896.doi: 10.12307/2025.147

• 骨与关节图像与影像Bone and joint imaging • 上一篇    下一篇

双髋关节MRI预测股骨头坏死塌陷风险

晋继明1，2，郝阳泉2，赵汝顺1，2，张玉婷2，姜永宏2，许  鹏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
  • 收稿日期:2024-01-05 接受日期:2024-03-09 出版日期:2025-03-28 发布日期:2024-10-10
  • 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:晋继明，男，1998年生，河南省鹤壁市人，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:
    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

Application of bilateral hip magnetic resonance imaging to predict risk of osteonecrosis of femoral head

Jin Jiming1, 2, Hao Yangquan2, Zhao Rushun1, 2, Zhang Yuting2, Jiang Yonghong2, Xu Peng2, 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
  • Received:2024-01-05 Accepted:2024-03-09 Online:2025-03-28 Published:2024-10-10
  • 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:Jin Jiming, 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:
    China Postdoctoral Science Foundation, No. 2017M613179 (to LC); Shaanxi Provincial Administration of Traditional Chinese Medicine Clinical Collaborative Innovation Project, No. 2020-ZXY-010 (to HYQ) 

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摘要：


文题释义：
双髋关节MRI：是临床上诊断双侧股骨头坏死的金标准，但大多数医院的此项检查仅可查看冠状面及横断面图像，缺少矢状面图像。
股骨头塌陷风险：以往根据MRI冠状面及矢状面中骨坏死病灶情况进行塌陷风险预测，具体方法包括坏死范围指数、改良Kerboul角、前坏死角等。

摘要
背景：MRI是诊断股骨头坏死的金标准，以往基于MRI图像预测股骨头坏死塌陷的方法多需要冠状面、矢状面图像联合评估。然而由于股骨头坏死好发于双侧，临床上大多医院检查时多行双侧髋关节MRI扫描，但双髋扫描仅可查看冠状面及横断面图像，难以获取矢状面图像，从而影响塌陷风险的评估。因此，建立一种应用双髋MRI可获取的图像评估早期股骨头坏死塌陷风险的方法有一定的临床实用价值。
目的：建立一种应用双髋关节MRI冠状面与横断面图像评估股骨头坏死塌陷风险的方法。
方法：回顾性分析2017年10月至2019年10月在西安交通大学附属红会医院门诊确诊的早期股骨头坏死患者111例(181髋)的病历资料。根据末次随访时股骨头塌陷情况分为2组，其中塌陷组69髋，未塌陷组112髋。在MRI影像系统上测量正中冠状面、横断面或其上下各一个层面图像上的坏死范围角度，以冠状面、横断面上坏死角两角之和作为联合坏死角，并取每髋3种联合坏死角的平均值得到每髋的平均联合坏死角。最后，分析3种联合坏死角及平均联合坏死角与股骨头坏死塌陷的相关性，利用受试者工作特征曲线评价4种联合坏死角预测塌陷的特异性与敏感性。
结果与结论：①末次随访69髋(38.1%)发生股骨头塌陷，纳入塌陷组；112髋(61.9%)未发生塌陷进展，纳入非塌陷组；②塌陷组与未塌陷组在ARCO分期方面比较差异有显著性意义(P < 0.001)；在年龄、体质量指数、随访时间、性别分布、发病侧别、致病因素等方面比较差异均无显著性意义(P > 0.05)；③独立样本t 检验结果提示，4种联合坏死角均与塌陷显著相关(P < 0.000 1)；且ARCOⅠ期、Ⅱ期中塌陷组与未塌陷组患者的联合坏死角相比差异均有显著性意义(P < 0.000 1)；④在受试者工作特征分析中，平均联合坏死角曲线下面积大于正中下一层面、正中层面、正中上一层面上的联合坏死角；⑤平均联合坏死角塌陷预测准确度高于正中下一层面、正中层面、正中上一层面上的联合坏死角；⑥提示平均联合坏死角对股骨头坏死塌陷风险的预测精准度较高，临床实用性较强，可考虑使用该方法对股骨头坏死塌陷风险进行预测。


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, 塌陷预测, MRI, 冠状面, 横断面, 联合坏死角

Abstract: BACKGROUND: Magnetic resonance imaging is the gold standard for the diagnosis of osteonecrosis of femoral head, and previous methods of predicting osteonecrosis of femoral head collapse based on magnetic resonance images mostly require the combined assessment of coronal and sagittal images. However, osteonecrosis of femoral head tends to occur bilaterally, most hospitals perform bilateral hip magnetic resonance imaging scans during clinical examinations, but the bilateral hip scans can only view coronal and cross-sectional images, and it is difficult to obtain sagittal images, which affects the assessment of the risk of collapse. Therefore, it is of clinical value to establish a method to assess the risk of early osteonecrosis of femoral head collapse by applying the images that can be obtained after bilateral hip magnetic resonance scanning. 
OBJECTIVE: To establish a method of applying coronal and cross-sectional images of bilateral hip magnetic resonance imaging to assess the risk of osteonecrosis of femoral head collapse. 
METHODS: The medical records of 111 patients (181 hips) with early-stage osteonecrosis of femoral head diagnosed at the outpatient clinic of Honghui Hospital Affiliated to Xi’an Jiaotong University from October 2017 to October 2019 were retrospectively analyzed. They were categorized into collapsed and non-collapsed groups according to the femoral head collapse at the final follow-up, with 69 hips in the collapsed group and 112 hips in the non-collapsed group. The angle of necrotic range on the images of median coronal plane, transverse plane or one level above and below it was measured on the magnetic resonance imaging system. The sum of the two angles of necrotic angle on the coronal and transverse planes was used as the combined necrotic angle. The average of the three combined necrotic angles of each hip was taken to get the average combined necrotic angle of each hip. Finally, the correlation between the three combined necrotic angles and the average combined necrotic angle with the collapse of osteonecrosis of femoral head was analyzed, and the specificity and sensitivity of the four combined necrotic angles in predicting collapse were evaluated by using receiver operating characteristic curves.
RESULTS AND CONCLUSION: (1) Totally 69 hips (38.1%) had femoral head collapse at the last follow-up and were included in the collapsed group; 112 hips (61.9%) did not have progression of collapse and were included in the non-collapsed group. (2) The difference between the collapsed group and the non-collapsed group in terms of Association Research Circulation Osseous (ARCO) stage was significant (P < 0.001). The difference in age, body mass index, follow-up time, gender distribution, side of onset, and causative factors was not significant (P > 0.05). (3) The results of independent samples t-test suggested that all four combined necrotic angles were significantly correlated with collapse (P < 0.000 1); and the differences in combined necrotic angles between the collapsed group and the non-collapsed group of ARCO stage I and the two groups of ARCO stage II were all significant (P < 0.000 1). (4) In the analysis of the receiver operating characteristic, the area under the curve of the average combined necrotic angle was greater than that of the combined necrotic angle on the lower level of the median, the middle level, and the upper level of the median. (5) The average combined necrotic angle had a higher accuracy in the prediction of collapse than the lower level of the median, the middle level, and the upper level of the combined necrotic angle. (6) It is concluded that the accuracy of the average combined necrotic angle in predicting the risk of osteonecrosis of femoral head collapse is higher, and the clinical practicability is stronger, so we can consider using this method to predict the risk of osteonecrosis of femoral head collapse.

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

Key words: osteonecrosis of femoral head, collapse prediction, MRI, coronal plane, cross section, combined necrotic angle

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