Koo K H, Kim R
Department of Orthopaedic Surgery, School of Medicine, Gyeong-Sang National University, Chinju, Republic of Korea.
J Bone Joint Surg Br. 1995 Nov;77(6):875-80.
In a randomised trial comparing core decompression with conservative treatment we tested the hypothesis that the extent of necrosis at the initial MRI predicts the subsequent risk of collapse of the femoral head. After the initial clinical evaluation, including plain radiography and MRI, 37 hips with early-stage osteonecrosis (ON) in 33 patients were randomly assigned to a core-decompression group or a conservatively-treated group. All were followed regularly by clinical evaluation, plain radiography and MRI at intervals of three months. The extent of ON was estimated on the basis of abnormal signal intensity in the weight-bearing portion of the femoral head as determined from a combination of coronal and sagittal MRIs. The arc of the necrotic portion in the mid-coronal image (A) and that in the mid-sagittal image (B) were used to quantify the extent of necrosis by the formula: (A/180) x (B/180) x 100. There was a strong correlation between this index and the risk of collapse before and after adjustment for age, gender, stage and treatment group. We conclude that the extent of the necrotic portion ascertain by this method is a major predictor of future collapse. We propose a systematic method of determining the index of the necrotic portion which may be clinically useful in the management of early-stage ON of the femoral head.
在一项比较髓芯减压术与保守治疗的随机试验中，我们检验了这样一个假设：初始磁共振成像（MRI）时的坏死范围可预测股骨头随后塌陷的风险。在包括X线平片和MRI在内的初始临床评估之后，将33例患者的37个早期骨坏死（ON）髋关节随机分为髓芯减压组或保守治疗组。所有患者均每隔三个月定期接受临床评估、X线平片和MRI检查。根据冠状面和矢状面MRI联合确定的股骨头负重部分的异常信号强度来评估骨坏死的范围。利用中冠状面图像（A）和中矢状面图像（B）中坏死部分的弧度，通过公式：（A/180）×（B/180）×100来量化坏死范围。在对年龄、性别、分期和治疗组进行调整前后，该指标与塌陷风险之间均存在很强的相关性。我们得出结论，通过该方法确定的坏死部分范围是未来塌陷的主要预测指标。我们提出了一种确定坏死部分指标的系统方法，这在股骨头早期ON的管理中可能具有临床实用性。
