基于X线片建立股骨头坏死新分型体系的临床意义

目的观察围塌陷期股骨头坏死在影像学上的表现形式,进行分类总结。 方法选择在广州中医药大学第一附属医院确诊为围塌陷期股骨头坏死且有完整影像资料的患者,排除髋部有先天畸形或有影响髋关节功能的疾病等。在双侧髋关节标准正位片上观察股骨头坏死硬化带的形态及其与髋臼"眉弓"的对应关系,在双侧髋关节蛙式侧位片上观察股骨头坏死硬化带的形态及其与股骨头前外侧柱的对应关系,根据不同表现形式进行分类。 结果共纳入266例435髋,在双侧髋关节标准正位片上观察到6种股骨头坏死硬化带的表现形式,分别是A型(硬化带边缘在眉弓内侧1/3以内)19(4.4%),B型(硬化带边缘在"眉弓"中间1/3内)89髋(20.1%),C1型(硬化带边缘在眉弓外侧1/3内)155髋(35.6%),C2型(硬化带边缘超过髋臼外侧缘)87髋(20.0%),D1型(硬化带呈环形,位于股骨头中心)47髋(10.8%),D2型(硬化带呈环形,位于股骨头负重区软骨下骨板)38髋(8.7%)。在双侧髋关节蛙式侧位片上观察到5种股骨头坏死硬化带的表现形式,分别是1型(硬化带边缘位于股骨头后内侧柱或中央柱)3髋(0.7%),2型(硬化带边缘位于股骨头后内侧柱或中央柱,深部累及前外侧柱)51髋(11.7%),3型(硬化带边缘位于股骨头前外侧柱)316髋(72.6%),4型(硬化带呈环形,位于股骨头中心)32髋(7.4%),5型(硬化带呈环形,位于股骨头负重区软骨下骨板)33髋(7.6%)。总结出435髋共有19种匹配结果,结合纳入髋数的塌陷率,初步确定蛙位3型匹配正位B、C1、C2和D2时,需要采取外科干预。 结论根据股骨头坏死硬化带在影像学上的表现形式建立正位和蛙式侧位分型,充分考虑股骨头外侧柱和前外侧柱的坏死累及情况,更能反映疾病的本质,为临床诊断、治疗和预后判断提供参考。

Clinical significance for new type of necrotic femoral head based on X-ray

ObjectiveTo observe the imaging manifestations of osteonecrosis of the femoral head (ONFH) during pericollapse stage and make classification and summary. MethodsThe research recruited ONFH patients who had complete image data from the First Affiliated Hospital of Guangzhou University of Chinese Medicine in the pericollapse stage, and the patients with congenital hip deformities and other diseases affecting the hip were exluded. The shape of sclerotic zone and its corresponding relations with "eyebrow arch" of acetabulum and anterolateral column of the femoral head were observed on bilateral hip standard radiograph and lateral radiograph of "frog position" respectively. The classification was performed according to the manifestation patterns. ResultsA total of 266 patients with 435 hips were enrolled. Six patterns of manifestation of the sclerotic zone were observed on bilateral hip standard radiograph, including type A (the edge of sclerotic zone was within the medial 1/3 of acetabular "eyebrow arch" ), type B (the edge was within the middle 1/3), type C1 (the edge was within the lateral 1/3), type C2 (the edge extends laterally to the acetabular edge), type D1 and type D2 (all the sclerotic zones presented ring shape locating at the center of the femoral head and the subchondral bone plate of the weight-bearing area of femoral head). Altogether 19 hips (4.4%) were type A, 89 hips (20.1%) were type B, 155 cases (35.6%) were type C1, 87 cases (20.0%) were type C2, 47 cases (10.8%) were type D1 and 38 cases (8.7%) were type D2. Five manifestation patterns of the sclerotic zone were also observed on bilateral hip frog lateral radiographs, including type 1 (the edge of sclerotic zone located at the posterior medial or central column of the femoral head), type 2(the edge was similar to type 1, and the anterolateral column was involved in the deep), type 3 (the edge located at the anterolateral column), type 4 and type 5 (all the edges presented ring shape locating at the center of the femoral head and the subchondral bone plate of the weight-bearing area of femoral head). Altogether three hips (0.7%) were type 1, 51 hips (11.7%) were type 2, 316 hips (72.6%) were type 3, 32 hips (7.4%) were type 4 and 33 hips (7.6%) were type 5. ConclusionDeveloping the anteroposterior and lateral images of "frog position" classification system based on the radiographic manifestation patterns of sclerotic zone in necrotic femoral head while considering the necrotic involvement of lateral and anterolateral column will be conducive to better understanding the nature of disease and provide useful information for clinical diagnosis, therapy and prognosis.