Department of Orthopaedic surgery, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, South Korea.
Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY.
J Arthroplasty. 2022 Jun;37(6):1074-1082. doi: 10.1016/j.arth.2022.02.009. Epub 2022 Feb 11.
The Association Research Circulation Osseous developed a novel classification for early-stage (precollapse) osteonecrosis of the femoral head (ONFH). We hypothesized that the novel classification is more reliable and valid when compared to previous 3 classifications: Steinberg, modified Kerboul, and Japanese Investigation Committee classifications.
In the novel classification, necrotic lesions were classified into 3 types: type 1 is a small lesion, where the lateral necrotic margin is medial to the femoral head apex; type 2 is a medium-sized lesion, with the lateral necrotic margin being between the femoral head apex and the lateral acetabular edge; and type 3 is a large lesion, which extends outside the lateral acetabular edge. In a derivation cohort of 40 early-stage osteonecrotic hips based on computed tomography imaging, reliabilities were evaluated using kappa coefficients, and validities to predict future femoral head collapse by chi-squared tests and receiver operating characteristic curve analyses. The predictability for future collapse was also evaluated in a validation cohort of 104 early-stage ONFH.
In the derivation cohort, interobserver reliability (k = 0.545) and intraobserver agreement (63%-100%) of the novel method were higher than the other 3 classifications. The novel classification system was best able to predict future collapse (P < .05) and had the best discrimination between non-progressors and progressors in both the derivation cohort (area under the curve = 0.692 [0.522-0.863], P < .05) and the validation cohort (area under the curve = 0.742 [0.644-0.841], P = 2.46 × 10).
This novel classification is a highly reliable and valid method of those examined. Association Research Circulation Osseous recommends using this method as a unified classification for early-stage ONFH.
Level III, diagnostic study.
研究骨循环协会开发了一种新的分类方法，用于早期（塌陷前）股骨头坏死（ONFH）。我们假设与 Steinberg、改良 Kerboul 和日本调查委员会分类法相比，新分类法更可靠和有效。
在新分类中，坏死病变分为 3 种类型：1 型为小病变，外侧坏死边缘位于股骨头顶点内侧；2 型为中等病变，外侧坏死边缘位于股骨头顶点和髋臼外侧缘之间；3 型为大病变，病变延伸至髋臼外侧缘以外。在基于 CT 成像的 40 例早期骨坏死髋中进行了推导队列研究，使用 Kappa 系数评估可靠性，并通过卡方检验和受试者工作特征曲线分析评估对未来股骨头塌陷的有效性。在 104 例早期 ONFH 的验证队列中也评估了对未来塌陷的预测能力。
在推导队列中，新型方法的观察者间可靠性（k=0.545）和观察者内一致性（63%-100%）高于其他 3 种分类法。新分类系统最能预测未来的塌陷（P<0.05），并且在推导队列（曲线下面积=0.692[0.522-0.863]，P<0.05）和验证队列（曲线下面积=0.742[0.644-0.841]，P=2.46×10）中，新分类法能够最好地区分非进展者和进展者。
该新型分类方法是一种高度可靠和有效的方法。研究骨循环协会建议将其作为早期 ONFH 的统一分类方法。
三级，诊断研究。
