Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Zhongshan, Guangdong, China.
Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
BMC Musculoskelet Disord. 2024 Sep 16;25(1):740. doi: 10.1186/s12891-024-07787-2.
This study aimed to developed a novel and practical method to quantify the involvement of lesion in osteonecrosis of the femoral head (ONFH). We hypothesized that the new metric large lesion ratio (LLR) had promising prognostic value.
A total of 131 hips with non-traumatic ONFH were included in this retrospective study. Patient aged 18-60 with MRI-confirmed diagnosis, and a minimum of 2-year follow-up or radiographic collapse progression during follow-up were included. Patients with prior hip surgery, incomplete data or advanced ONFH at baseline (femoral head collapse > 2 mm or osteoarthritis) were excluded. Involvement of necrotic lesion was evaluated by calculating LLR. The differences of LLR between collapse progression and non-progression groups were investigated, and the differences among different scanning parameters groups were also examined. Prognostic value of LLR was examined by multivariate regression analysis. Receiver operating characteristic curves (ROC) were constructed and areas under the curve (AUC) were compared.
The median of LLR was 66.67% in the collapse progression group, which was significantly higher compared with 25.00% in the non-progression group (P < 0.001). Subgroups analysis showed that LLR were significantly higher in the collapse progression group of Japanese Investigation Committee type C1 (P < 0.001)and C2 (P = 0.002). Multivariate regression showed that LLR were independently correlated with collapse progression (OR, 1.46 [95% CI, 1.24-1.78]; P < 0.001). ROC analysis showed that the AUC for LLR was 0.84, outperforming the 0.74 AUC OF the JIC classification.
LLR could served as a efficient tool to assess the risk of collapse progression and guide the selection of treatment strategy.
本研究旨在开发一种新颖实用的方法来量化股骨头坏死（ONFH）病变的受累程度。我们假设新的指标大病变比（LLR）具有有前途的预后价值。
本回顾性研究共纳入 131 髋非创伤性 ONFH 患者。纳入标准为：年龄 18-60 岁，MRI 确诊，随访至少 2 年或随访过程中出现影像学塌陷进展；排除标准为：既往髋关节手术史、资料不完整或基线时存在晚期 ONFH（股骨头塌陷>2mm 或骨关节炎）。通过计算 LLR 评估坏死病变的受累情况。研究比较了塌陷进展组与非进展组之间的 LLR 差异，同时还比较了不同扫描参数组之间的差异。采用多变量回归分析探讨了 LLR 的预后价值。构建了受试者工作特征曲线（ROC），并比较了曲线下面积（AUC）。
塌陷进展组的 LLR 中位数为 66.67%，明显高于非进展组的 25.00%（P<0.001）。亚组分析显示，日本研究委员会（JIC）分型 C1 （P<0.001）和 C2 （P=0.002）组的塌陷进展组 LLR 明显更高。多变量回归分析显示，LLR 与塌陷进展独立相关（OR，1.46[95%CI，1.24-1.78]；P<0.001）。ROC 分析显示，LLR 的 AUC 为 0.84，优于 JIC 分类的 0.74 AUC。
LLR 可作为评估塌陷进展风险和指导治疗策略选择的有效工具。
