Yang Jun-Zheng, Chen Peng, Chen Bai-Hao, Zhao Bin
The Fifth Clinical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China.
Department of Orthopaedics, The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China.
World J Clin Cases. 2023 Oct 6;11(28):6733-6743. doi: 10.12998/wjcc.v11.i28.6733.
Subchondral fatigue fracture of the femoral head (SFFFH) mainly occurs in young military recruits and might be confused with osteonecrosis of the femoral head. However, less research focuses on the risk factor for SFFFH.
To evaluate the intrinsic risk factors for SFFFH in young military recruits.
X-ray and magnetic resonance imaging data were used for analysis. Acetabular anteversion of the superior acetabulum, acetabular anteversion of the center of the acetabulum (AVcen), anterior acetabular sector angle (AASA), posterior acetabular sector angle, superior acetabular sector angle, neck-shaft angle (NSA), inferior iliac angle (IIA), and ischiopubic angle were calculated. Then, logistic regression, receiver operating characteristic curve analysis, and independent samples -test were performed to identify the risk factors for SFFFH.
Based on the results of logistic regression, age [odds ratio (OR): 1.33; 95% confidence interval (95%CI): 1.12-1.65; = 0.0031] and treatment timing (OR: 0.86; 95%CI: 0.75-0.96; = 0.015) could be considered as the indicators for SFFFH. AVcen ( = 0.0334), AASA ( = 0.0002), NSA ( = 0.0007), and IIA ( = 0.0316) were considered to have statistical significance. Further, AVcen (OR: 1.41; 95%CI: 1.04-1.95) and AASA (OR: 1.44; 95%CI: 1.21-1.77), especially AASA (area under curve: 66.6%), should be paid much more attention due to the higher OR than other indicators.
We have for the first time unveiled that AASA and age could be key risk factors for SFFFH, which further verifies that deficient anterior coverage of the acetabulum might be the main cause of SFFFH.
股骨头软骨下疲劳骨折（SFFFH）主要发生在年轻新兵中，可能与股骨头坏死相混淆。然而，针对SFFFH危险因素的研究较少。
评估年轻新兵中SFFFH的内在危险因素。
采用X线和磁共振成像数据进行分析。计算上髋臼的髋臼前倾角、髋臼中心的髋臼前倾角（AVcen）、髋臼前扇形角（AASA）、髋臼后扇形角、上髋臼扇形角、颈干角（NSA）、下髂角（IIA）和耻骨角。然后，进行逻辑回归、受试者工作特征曲线分析和独立样本检验，以确定SFFFH的危险因素。
基于逻辑回归结果，年龄[比值比（OR）：1.33；95%置信区间（95%CI）：1.12 - 1.65；P = 0.0031]和治疗时机（OR：0.86；95%CI：0.75 - 0.96；P = 0.015）可被视为SFFFH的指标。AVcen（P = 0.0334）、AASA（P = 0.0002）、NSA（P = 0.0007）和IIA（P = 0.0316）被认为具有统计学意义。此外，由于AVcen（OR：1.41；95%CI：1.04 - 1.95）和AASA（OR：1.44；95%CI：1.21 - 1.77），尤其是AASA（曲线下面积：66.6%）的OR高于其他指标，应给予更多关注。
我们首次揭示AASA和年龄可能是SFFFH的关键危险因素，这进一步证实髋臼前方覆盖不足可能是SFFFH的主要原因。
