Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.
Orthopaedic Research Institute of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
J Orthop Surg Res. 2024 Sep 19;19(1):577. doi: 10.1186/s13018-024-05058-3.
There is a scarcity of evidence regarding the potential relationship between the size and location of necrotic lesions, which must be understood to provide optimal joint-preserving treatment. The purpose of this study was to characterize the distribution patterns of necrotic lesions of varying sizes in early-stage osteonecrosis of femoral head (ONFH) with the use of three-dimensional mapping.
We retrospectively evaluated clinical CT images of the hips that were performed in the Third Hospital of Hebei Medical University from January 2018 to December 2022 and collected all CT images diagnosed with stage I and II ONFH. Three-dimensional structures that included both necrotic lesions and normal areas of the femoral heads were reconstructed and divided into eight regions to record their size and location. CT images for all lesions were superimposed onto a standard template, and three-dimensional mapping was created to determine the presence of concentrated areas of lesions.
In a cohort of 143 patients with stage I and II ONFH, a total of 150 hips were reviewed. For lesions with less than 15% of the femoral head volume, necrotic lesions predominantly involve regions I, III, and V, with region I showing concentration. For lesions with volumes ranging from 15 to 30%, necrotic lesions exhibited a wider distribution across regions I, II, III, IV, V, and VII, with significant concentrations in regions I, III, and V. For lesions exceeding 30% of the femoral head volume, the necrotic lesions were extensively distributed across nearly the entire femoral head, with a notable expansion of the concentrated necrotic areas.
The distribution of necrotic lesions varies with lesion size, with smaller lesions primarily concentrated in the anterior and medial regions of the femoral head, particularly in the anterosuperior region, while larger lesions expand to the lateral and inferior regions. These findings enhance existing classification systems and provide crucial insights for guiding hip-preserving surgical planning and approaches.
坏死病变的大小和位置之间可能存在关联，但相关证据有限，为了提供最佳的保关节治疗，必须了解这一点。本研究旨在使用三维（3D）图谱对早期股骨头坏死（ONFH）的不同大小的坏死病变分布模式进行特征描述。
我们回顾性评估了 2018 年 1 月至 2022 年 12 月在河北医科大学第三医院进行的髋关节 CT 图像，收集了所有诊断为 I 期和 II 期 ONFH 的 CT 图像。重建包括坏死病变和股骨头正常区域的 3D 结构，并将其分为 8 个区域，以记录其大小和位置。对所有病变的 CT 图像进行叠加，并创建 3D 图谱，以确定病变集中区域的存在。
在 143 例 I 期和 II 期 ONFH 患者的队列中，共对 150 髋进行了回顾性分析。对于体积小于股骨头 15%的病变，坏死病变主要累及 I、III 和 V 区，I 区病变集中。对于体积在 15%至 30%之间的病变，坏死病变在 I、II、III、IV、V 和 VII 区广泛分布，在 I、III 和 V 区有明显的集中。对于体积超过股骨头 30%的病变，坏死病变广泛分布于整个股骨头，集中坏死区明显扩大。
坏死病变的分布随病变大小而变化，较小的病变主要集中在股骨头的前内侧区域，特别是在前方和上侧，而较大的病变扩展到外侧和下侧。这些发现增强了现有的分类系统，并为指导保髋手术规划和方法提供了重要的见解。
