成人非创伤性股骨头坏死塌陷预测的临床研究

Estimation of Femoral Head Collapse in Adult Patients with Non-traumatic Occlusion Femoral Head Necrosis

目的:通过临床实验探讨股骨头坏死(ONFH)病灶大小、部位与股骨头塌陷的关系。方法:将12例(15髋)患者行人工关节置换术后取出的股骨头进行医学标本制作,并测量股骨头的坏死体积及坏死体积占整个股骨头体积的百分比(简称坏死体积比)和坏死表面积及坏死表面积占整个股骨头表面积的百分比(简称坏死表面积比)的数据,并进行统计分析。结果:股骨头劈开后测量整个股骨头的平均体积为50.0 cm3(35.6～59.4cm3)。坏死区域的平均体积21.6 cm3(12.0～29.8 cm3);坏死体积比平均值43.5%(26.6%～64.3%),其中坏死体积比>40%有9髋,30%～40%4髋,<30%2髋。坏死表面积25～35 cm2有8例,36～45 cm26例;坏死表面积比>50%13例。结论:坏死病灶体积>30%时,ONFH的塌陷率高达87%;<30%时坏死病灶的位置对病情进展起关键作用。坏死表面积>25 cm2,坏死表面积比>50%时,ONFH的塌陷份额>87%。提示坏死病灶的大小与股骨头塌陷的危险性密切相关。

Objective：By using clinical trial to investigate the relationship between the location and size of the femoral head necrosis and femoral head collapse.Methods： From Oct.2006 to Oct.2008,a clinical trial on 12 cases of femoral head necrosis（15 hips） receiving prosthetic replacement of joint was performed.Results： The average volume of the whole femoral head,which was measured by splitted femoral head,was 50.0 cm3（35.6-59.4 cm3）.The average volume of femoral head necrosis area was 21.6 cm3（12.0-29.8 cm3）.The average ratio of the volume of femoral head necrosis area on the whole femoral head（simply named the ratio of necrosis volume） was 43.5%（26.6%-64.3%）.The ratio of necrosis volume in 9 hips,4 hips,and 2 hips was more than 40%,30%-40% and less than 30%.The volume of femoral head necrosis area in 8 and 6 hips was 25-35 and 36-45 cm2.The ratio of the volume of femoral head necrosis area in 13 hips was more than 50%.Conclusion： The size of necrosis is closely correlated with the risk of femoral head collapse.When the volume ratio of femoral head necrosis is more than 30%,the rate of femoral head necrosis collapse is 87% and the collapse has high risk.When the volume ratio of femoral head necrosis is less than 30%,the location of collapse focus has a key role in the progression of pathogenetic condition.When the surface area of necrosis is more than 25 cm2 and the ratio of surface area of necrosis is more than 50%,the rate of femoral head necrosis collapse is 87% and the femoral head necrosis has high risk.