Department of Orthopaedics, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China.
Department of Orthopaedics, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
J Bone Joint Surg Am. 2022 Apr 6;104(Suppl 2):25-32. doi: 10.2106/JBJS.20.00478.
Joint-preserving treatments for osteonecrosis of the femoral head (ONFH) are an area of significant interest in orthopaedics as they may restore function and provide durable benefit to patients who would otherwise require early total hip arthroplasty. Studies reporting the outcomes for these procedures generally rely on a combination of radiographic and clinical outcomes. However, there is not currently a standardized radiographic scoring system that allows for objective reporting of radiographic outcomes following these procedures. This article introduces a novel scoring system (Beijing University of Chinese Medicine X-ray evaluation, BUCMXE) based on Anteroposterior (AP) hip radiographs to allow for objective evaluation and comparison of postoperative outcomes following joint-preserving treatments for ONFH.
The proposed scoring system utilizes AP radiographs of the hip and consists of a total score (0-10) derived from the sum of subscores in 3 domains: femoral head morphology, osteonecrotic lesion, and degree of osteoarthritis. Each radiographic parameter is scored from 0 (normal) to 3 or 4 (advanced disease). The scoring model was retrospectively applied to a cohort of patients who had undergone core decompression and cancellous bone grafting procedures by the principal investigator.
The BUCMXE provided a clear and reproducible means of quantifying and communicating radiographic changes over the course of follow-up in our study cohort. Statistical analysis demonstrated that the BUCMXE was sensitive to detect the radiographic changes associated with the index procedure. The median total score was reduced from 3 preoperatively to 2 at the initial (3-month) follow-up for this cohort. This change was attributable to the obvious improvement of osteonecrotic lesion in patients who had more advanced disease at the time of their procedure.
The BUCMXE system allowed for objective quantification of radiographic changes following joint-preserving hip surgery in our cohort. Statistical analysis of BUCMXE scores demonstrated that the scoring system was sensitive to detect subtle radiographic changes associated with disease progression in the follow-up period.
Therapeutic Level III.
保髋治疗股骨头坏死（ONFH）是矫形外科领域的一个重要研究方向，因为它可以为那些需要早期全髋关节置换术的患者恢复功能并提供持久的益处。报道这些手术结果的研究通常依赖于影像学和临床结果的综合评估。然而，目前还没有一种标准化的影像学评分系统能够客观地报告这些手术后的影像学结果。本文介绍了一种新的评分系统（北京中医药大学 X 射线评价系统，BUCMXE），它基于髋关节前后位（AP）X 线片，用于客观评估和比较保髋治疗股骨头坏死的术后结果。
该评分系统利用髋关节的 AP 射线片，由三个域的子评分总和得出总分（0-10）：股骨头形态、骨坏死病变和骨关节炎程度。每个影像学参数的评分范围为 0（正常）至 3 或 4（晚期疾病）。评分模型被回顾性地应用于一组由主要研究者进行的核心减压和松质骨移植手术的患者。
BUCMXE 为我们的研究队列提供了一种清晰且可重复的方法，用于在随访过程中量化和沟通影像学变化。统计分析表明，BUCMXE 能够敏感地检测到与索引手术相关的影像学变化。该队列的总评分中位数从术前的 3 分降低到初始（3 个月）随访时的 2 分，这归因于在手术时病变程度更严重的患者的骨坏死病变明显改善。
BUCMXE 系统允许对我们队列中保髋髋关节手术后的影像学变化进行客观量化。BUCMXE 评分的统计分析表明，该评分系统能够敏感地检测到随访期间与疾病进展相关的细微影像学变化。
治疗性 3 级。
