基于三柱结构的股骨头坏死分型——中日友好医院分型

 目的 通过分析非创伤性股骨头坏死的进展规律, 创建新的股骨头坏死分型方法。方法 基于Herring 对Legg-Perthes 病的三柱概念, 将冠状面股骨头分为内侧柱、中央柱及外侧柱, 选择MR 检查T1WI 冠状位正中层面图像, 依据坏死灶占据三柱结构的位置, 建立中日友好医院(China-Japan Friendship Hospital, CJFH)股骨头坏死分型体系。依据此分型方法及日本骨坏死研究会(Japanese Investigation Committee, JIC)分型分别对严重急性呼吸综合征患者的股骨头坏死(153 髋)进行分型, 统计其自然转归, 比较两种分型方法的坏死塌陷率。结果 CJFH分型: 内侧型(A 型), 坏死灶累及内侧柱;中央型(B 型), 坏死灶累及中央柱和内侧柱;外侧型(C 型): 凡累及外侧柱的坏死。依据坏死灶累及外侧柱的不同位置将外侧型分为次外侧型(C1 型)、极外侧型(C2 型)及全股骨头型(C3 型)。股骨头坏死患者自然进展显示, 两种分型方法的A、B、C三型股骨头塌陷率不同;CJFH分型C3 型塌陷率94.4%, C2 型塌陷率100%, 均高于C1 型42.6%;CJFH分型C2、C3 型合并塌陷率95.3%, 高于JIC 分型C2 型塌陷率72.3%。差异均有统计学意义。结论 CJFH 分型C2、C3 型预测股骨头塌陷的敏感性高于JIC 分型C2 型。基于三柱结构的CJFH 分型对股骨头坏死预后的预测准确性高, 应用简便。

The classification of osteonecrosis of the femoral head based on the three pillars structure: China-Japan Friendship Hospital (CJFH) classification

Objective To explore the regular progressive pattern of nontraumatic osteonecrosis of the femoral head (ONFH) in order to establish the reliable and convenient new classification of ONFH. Methods The coronal section of the femoral head was divided into three pillars (medial, central and lateral). The mid-coronal section of the femoral head on MRI was selected. The China-Japan Friendship Hospital (CJFH) classification of ONFH was established according to the site of necrotic focus in three pillars. A total of 153 hips with ONFH were classified according to CJFH classification and Japanese Investigation Committee (JIC) classification, respectively. The collapse rate was observed and compared between both classifications of ONFH. Results The CJFH classification for ONFH consists of 3 types: type A, the medial pillar was involved; type B, the medial and central pillars were involved; type C, the lateral pillar was involved. According to site of necrosis focus in the lateral pillar, the type C was divided into 3 types: C1, there pillars were involved but there still was some normal tissue in lateral pillar; C2, partial central pillar and all lateral pillar were involved; C3, the whole femoral head was involved. The natural history of the ONFH showed the collapse rate of type C2 and C3 in CJFH classification (95.3%) was higher than that (72.3%) of type C2 in JIC classification. Conclusion The CJFH classification of ONFH based on three pillars is more sensitive than JIC classification in predicting collapse of the femoral head. Moreover, the CJFH classification is convenient to use.