Guangdong research institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, 510405, Guangdong, China.
Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.
BMC Musculoskelet Disord. 2023 Sep 26;24(1):757. doi: 10.1186/s12891-023-06890-0.
The aim of this study was to construct a lateral classification system for nontraumatic osteonecrosis of femoral head (NONFH) through three-dimensional reconstruction of the necrotic area to assist in evaluating the prognosis of patients with JIC type C1.
Retrospective analysis of patients with JIC type C1 NONFH from January 2018 to December 2020. All patients were followed up for more than 3.5 years. The patients were divided into collapse group and non-collapse group according to whether the femoral head collapsed during the follow-up.Lateral classification system for femoral head necrosis is constructed through three-dimensional reconstruction of the necrotic area.Comparison of lateral classification system,midsagittal necrosis angle(MNA)and general data between the two groups.Furthermore, ROC curve analysis and survival analysis were performed.
318 patients were included in this study.There was a significant difference between the two groups in the lateral classification system (P < 0.05). In addition, the MNA in the collapsed group was significantly greater than that in the non-collapse group(P < 0.05). As revealed by the results of ROC analysis, the cutoff point of MNA was 104.5° (P < 0.05).According to the survivorship analysis, the mean survival time of the hips of patients with MNA less than 104.5°was greater than that of patients with MNA over 104.5° (P < 0.05). The survival rates of 3.5 years femoral head were 45.8%, 33.7%, 14.8%, 93.0%, and 100% for lateral classification system 1, 2, 3, 4, and 5, respectively.
Necrosis involving the anterior aspect of the femoral head is an important risk factor for collapse. The Lateral classification system can effectively predict the femoral head collapse in JIC C1 type NONFH patients, supplementing the deficiency of JIC classification in evaluating the front of the femoral head.
本研究旨在通过对坏死区域进行三维重建，构建非创伤性股骨头坏死（NONFH）的外侧分型系统，以辅助评估 JIC 分型 C1 型患者的预后。
回顾性分析 2018 年 1 月至 2020 年 12 月 JIC 分型 C1 型 NONFH 患者。所有患者均随访 3.5 年以上。根据随访期间股骨头是否塌陷，将患者分为塌陷组和未塌陷组。通过坏死区域的三维重建构建股骨头坏死外侧分型系统。比较两组之间的外侧分型系统、中矢状位坏死角（MNA）和一般资料。进一步进行 ROC 曲线分析和生存分析。
本研究共纳入 318 例患者。两组患者的外侧分型系统比较差异有统计学意义（P < 0.05）。此外，塌陷组的 MNA 明显大于未塌陷组（P < 0.05）。ROC 分析结果显示，MNA 的截断点为 104.5°（P < 0.05）。生存分析结果显示，MNA 小于 104.5°的患者髋关节平均生存时间大于 MNA 大于 104.5°的患者（P < 0.05）。外侧分型系统 1、2、3、4、5 组 3.5 年股骨头的生存率分别为 45.8%、33.7%、14.8%、93.0%和 100%。
股骨头前侧的坏死是股骨头塌陷的重要危险因素。外侧分型系统可有效预测 JIC 分型 C1 型 NONFH 患者股骨头塌陷，补充 JIC 分型对股骨头前侧评估的不足。
