The First Clinical Medical College, Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, China.
The Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong Province, China.
Int Orthop. 2022 Mar;46(3):423-431. doi: 10.1007/s00264-021-05081-7. Epub 2021 May 27.
Our research developed a novel approach to quantitatively evaluate the boundary of necrotic lesions in osteonecrosis of the femoral head (ONFH) and to explore its diagnostic value in predicting bone collapse of the femoral head.
A retrospective cross-sectional study was conducted in our institution, and 146 hips (121 cases) identified as ONFH were recruited. The anterior and lateral boundaries of each enrolled subject were measured in standard anteroposterior (AP) view and frog-leg (FL) view of plain radiographic images, the intact rate of which was then calculated and presented as the anteroposterior view intact ratio (APIR) and frog-leg view intact ratio (FLIR), respectively. Univariate and multivariate logistic regression analyses were performed to identify risk factors for collapse. A receiver operating characteristic (ROC) curve analysis was performed to determine the sensitivity, specificity and cutoff value of the APIR and FLIR. A Kaplan-Meier (K-M) analysis was applied to calculate the survival rate of the femoral head, and bone collapse of the femoral head was regarded as the endpoint.
Femoral head collapse was observed in 61 hips during the follow-up period. Patients with or without femoral head collapse were categorized into the collapse group and non-collapse group, respectively. The mean follow-up time was 3.7 years (2-9) for the collapse group and 7.7 years (5-20) for the non-collapse group. Univariate and multivariate logistic regression analysis and ROC analysis showed that APIR (< 25.61%) and FLIR (< 24.43%) were significantly associated with femoral head collapse. The K-M survival curves indicated that the overall survival rate of APIR (≥ 25.61%) was 94.8% at 7.5 years and 76.6% at 10 years, while that of FLIR (≥ 24.43%) was 87.3% at 7.5 years and ten years.
The present study demonstrates that APIR and FLIR are of high diagnostic value in the early and middle stages of ONFH. APIR and FLIR can be used to predict the occurrence of femoral head collapse in patients with JIC classification types B and C1. The measurement of these two parameters in plain radiography images may contribute to the selection of a proper hip preservation strategy.
本研究旨在开发一种定量评估股骨头坏死（ONFH）中坏死病变边界的新方法，并探讨其在预测股骨头骨塌陷中的诊断价值。
本研究为回顾性病例对照研究，共纳入我院确诊为 ONFH 的 146 髋（121 例）。在标准前后位（AP）和蛙式位（FL）平片上测量每个纳入患者的前后位和外侧边界，分别计算完整率并表示为前后位完整率（APIR）和蛙式位完整率（FLIR）。采用单因素和多因素 logistic 回归分析确定塌陷的危险因素。采用受试者工作特征（ROC）曲线分析评估 APIR 和 FLIR 的灵敏度、特异性和截断值。采用 Kaplan-Meier（K-M）分析计算股骨头的生存率，以股骨头塌陷为终点。
随访期间有 61 髋出现股骨头塌陷。将患者分为有塌陷组和无塌陷组。塌陷组的平均随访时间为 3.7 年（2-9 年），无塌陷组为 7.7 年（5-20 年）。单因素和多因素 logistic 回归分析及 ROC 分析表明，APIR（＜25.61%）和 FLIR（＜24.43%）与股骨头塌陷显著相关。K-M 生存曲线表明，APIR（≥25.61%）的总体生存率在 7.5 年时为 94.8%，在 10 年时为 76.6%，而 FLIR（≥24.43%）的总体生存率在 7.5 年时为 87.3%，在 10 年时为 76.6%。
本研究表明，APIR 和 FLIR 在 ONFH 的早期和中期具有较高的诊断价值。APIR 和 FLIR 可用于预测 JIC 分型 B 和 C1 患者股骨头塌陷的发生。在平片上测量这两个参数可能有助于选择合适的保髋策略。
