Wei Qiu-Shi, He Min-Cong, He Xiao-Ming, Lin Tian-Ye, Yang Peng, Chen Zhen-Qiu, Zhang Qing-Wen, He Wei
Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China.
Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China.
J Hip Preserv Surg. 2022 Mar 9;9(1):10-17. doi: 10.1093/jhps/hnac006. eCollection 2022 Jan.
Load-bearing capacity of the bone structures of anterolateral weight-bearing area plays an important role in the progressive collapse in osteonecrosis of the femoral head (ONFH). The purpose of this study is to assess the efficacy of combined evaluation of anteroposterior (AP) and frog-leg lateral (FLL) view in diagnosing collapse. Between December 2016 and August 2018, a total of 478 hips from 372 patients with ONFH (268 male, 104 female; mean age 37.9 ± 11.4 years) were retrospectively evaluated. All patients received standard AP and FLL views of hip joints. Japanese Investigation Committee (JIC) classification system was used to classify necrotic lesion in AP view. Anterior necrotic lesion was evaluated by FLL view. All patients with pre-collapse ONFH underwent non-operative hip-preserving therapy. The collapse rates were calculated and compared with Kaplan-Meier survival analysis with radiological collapse as endpoints. Forty-four (44/478, 9.2%) hips were classified as type A, 65 (65/478, 13.6%) as type B, 232 (232/478, 48.5%) as type C1 and 137 (137/478, 28.7%) as type C2. Three hundred cases (300/478, 62.5%) were collapsed at the initial time point. Two hundred and twenty six (226/300, 75.3%) hips and 298 (298/300, 99.3%) hips collapse were identified with AP view and FLL view, respectively. An average follow-up of 37.0 ± 32.0 months was conducted to evaluate the occurrence of collapse in 178 pre-collapse hips. Collapses occurred in 89 hips (50.0%). Seventy-seven (77/89, 86.5%) hips were determined with AP view alone and 85 (85/89, 95.5%) hips were determined with the combination of AP and FLL views. The collapse rates at five years were reported as 0% and 0%, 16.2% and 24.3%, 58.3% and 68.1% and 100% and 100% according to AP view alone or combination of AP and FLL views for types A, B, C1 and C2, respectively. The collapse can be diagnosed more accurately by combination of AP and FLL views. Besides, JIC type A and type B ONFH can be treated with conservative hip preservation, but pre-collapse type C2 ONFH should be treated with joint-preserving surgery. Type C1 needs further study to determine which subtype has potential risk of collapse.
股骨头前外侧负重区骨结构的承载能力在股骨头坏死（ONFH）的进行性塌陷中起重要作用。本研究的目的是评估前后位（AP）和蛙式侧位（FLL）联合评估在诊断塌陷方面的疗效。2016年12月至2018年8月，对372例ONFH患者（男268例，女104例；平均年龄37.9±11.4岁）的478个髋关节进行回顾性评估。所有患者均接受髋关节标准AP位和FLL位X线片检查。采用日本调查委员会（JIC）分类系统对AP位的坏死病变进行分类。通过FLL位评估前方坏死病变。所有塌陷前期ONFH患者均接受保髋非手术治疗。计算塌陷率，并以放射学塌陷为终点进行Kaplan-Meier生存分析比较。44个（44/478，9.2%）髋关节被分类为A型，65个（65/478，13.6%）为B型，232个（232/478，48.5%）为C1型，137个（137/478，28.7%）为C2型。300例（300/478，62.5%）在初始时间点发生塌陷。分别通过AP位和FLL位确定226个（226/300，75.3%）和298个（298/300，99.3%）髋关节发生塌陷。对178个塌陷前期髋关节进行平均37.0±32.0个月的随访，以评估塌陷的发生情况。89个髋关节（50.0%）发生塌陷。仅通过AP位确定77个（77/89，86.5%）髋关节发生塌陷，通过AP位和FLL位联合确定85个（85/89，95.5%）髋关节发生塌陷。据AP位单独或AP位与FLL位联合评估，A、B、C1和C2型的五年塌陷率分别报告为0%和0%、16.2%和24.3%、58.3%和68.1%、100%和100%。联合AP位和FLL位可更准确地诊断塌陷。此外，JIC A型和B型ONFH可采用保守保髋治疗，但塌陷前期C2型ONFH应采用保关节手术治疗；C1型需要进一步研究以确定哪种亚型具有塌陷的潜在风险。
