非创伤性股骨头坏死的塌陷预测优化研究

An optimization study of predicting scheme on non-traumatic osteonecrosis of femoral head

目的筛选、优化相对准确可行的股骨头塌陷预测方法,为治疗方法的选择和疾病转归的估计提供依据。方法收集45例(75髋)在中国中医科学院望京医院就诊的股骨头坏死患者双髋关节X线正位、蛙式位片及MRIT1加权正中冠状位片,由扫描或照相机拍摄并以JPEG格式储存,通过画图工具、图像处理软件,分别采用Ohzono法、Kerboul法、SuganoX线法、Laffirgue法、SuganoMRI法等五种常用的方法进行塌陷预测,并与实际塌陷情况对比,然后采用χ2检验,比较各种预测结果与实际塌陷率之间的差异。结果 45例(75髋)中,实际塌陷33髋,塌陷率为44%,男性45.9%、女性42.1%(P>0.05);Ohzono法、Kerboul法、SuganoX线法、Laffirgue法、SuganoMRI法预测塌陷率分别是65.33%、68.00%、48.00%、85.33%、81.33%;与实际塌陷结果比较,SuganoX线法48.00%的塌陷结果与实际44%的塌陷结果相近(P>0.05),其余方法预测结果差别较大(P<0.01)。结论 SuganoX线法对塌陷的预测较为准确,且其操作简便,具有一定的临床推广价值。

subjective To provide evidence for treating modality selection and prognosis forecasting of non-traumatic osteonecrosis of femoral head (NONFH) by checking and optimizing a precise and feasible predicting scheme. Methods Imaging data of 45 cases (75 hips) with NONFH that had been treated in Wangjing hospital of China Academy of Chinese Medical Science were collected. Specifically, anterior- posterior and frog-leg lateral radiography as well as coronal T1 weighted imaging of subjects sampled by scanner or digital camera were processed by drawing software. Then they were applied in five models as MRI method of Ohzono (MMO) and Suagno (MMS), radiography method of Sugano (RMS) and method of Kerboul (MK) and Laffire (ML) for collapse-prediction. At last, the real collapse rate and predicting ones were analyzed by chi-square test. Results Of total 75 hips, 33 hips experienced collapse which meant a 44% collapse rate. There was no difference between male collapse rate which was 45.9% and its female counterpart which was 42.1% (P>0.05). The occurrence rate of collapse prognosticated by MMO, MK, RMS, ML and MMS were 65.33%, 68.00%, 48.00%, 85.33% and 81.33% respectively. According to these data, result of RMS (48.00%) was the most similar one to real outcome (44%) in that there was no statistical difference between them (P<0.01). Conclusion RMS generates the closet result to real outcome in addition to its easiness in performing which indicates that it is worthwhile for popularization.