Department of Orthopaedics, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, P.R. China.
Traumatology & Orthopedics Institute of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, P.R. China.
J Bone Joint Surg Am. 2022 Apr 6;104(Suppl 2):47-53. doi: 10.2106/JBJS.20.00507.
Femoral head collapse (FHC) is associated with a poor prognosis in osteonecrosis of the femoral head (ONFH). Preserved angles (PAs), including the lateral preserved angle (LPA), the anterior preserved angle (APA) and the combined preserved angle (CPA), can be used to quantify the extent of femoral head necrosis and predict the risk of femoral head collapse. The purpose of this retrospective cohort study was to assess the efficacy of these preserved angles in the prediction of femoral head collapse using plain radiographs.
Patients with ONFH treated conservatively between January 2010 and January 2019 were analyzed retrospectively to assess the risk of FHC. A logistic regression model was used to evaluate the independent prognostic factors associated with FHC, including age, sex, etiology, onset of symptom, The Japanese Investigation Committee classification, and PAs (LPA, APA, and CPA).
A total of 137 patients, with 180 hips, had follow-up of at least two years and were included. During the follow-up period, FHC occurred in 89 hips (49.44%) after the initial diagnosis. Multivariable analysis indicated that CPA (odds ratio [OR] = 0.95; 95%CI = 0.93-0.97; P < 0.01) was a stronger predictor of femoral head collapse compared with the Japanese Investigation Committee classification (OR = 2.40, 95%CI = 0.92-6.25; P > 0.01). The receiver operating characteristic and survival curve analyses revealed that the predictive cutoff point for the CPA was 118.7° (sensitivity = 96.70%, specificity = 79.78%, log-rank test: P < 0.01).
Assessment of preserved angles on plain radiographs is a simple method to quantify the extent of lateral and anterior necrosis of the femoral head. Specifically, CPA has a potential value in predicting femoral head collapse.
股骨头塌陷(FHC)与股骨头坏死(ONFH)的预后不良相关。保留角(PA),包括外侧保留角(LPA)、前保留角(APA)和联合保留角(CPA),可用于定量评估股骨头坏死的程度并预测股骨头塌陷的风险。本回顾性队列研究的目的是使用普通 X 线片评估这些保留角在预测股骨头塌陷中的疗效。
回顾性分析 2010 年 1 月至 2019 年 1 月期间接受保守治疗的 ONFH 患者,以评估 FHC 的风险。使用逻辑回归模型评估与 FHC 相关的独立预后因素,包括年龄、性别、病因、症状发作、日本调查委员会分类和 PA(LPA、APA 和 CPA)。
共纳入 137 例患者,180 髋,随访至少 2 年。在随访期间,89 髋(49.44%)在初始诊断后发生 FHC。多变量分析表明,CPA(比值比 [OR] = 0.95;95%CI = 0.93-0.97;P < 0.01)比日本调查委员会分类(OR = 2.40,95%CI = 0.92-6.25;P > 0.01)是股骨头塌陷更强的预测因素。受试者工作特征和生存曲线分析表明,CPA 的预测截断点为 118.7°(灵敏度=96.70%,特异性=79.78%,对数秩检验:P < 0.01)。
在普通 X 线片上评估保留角是一种简单的方法,可以定量评估股骨头外侧和前侧坏死的程度。具体来说,CPA 具有预测股骨头塌陷的潜在价值。