影响股骨头坏死临床疗效及预后的危险因素

The clinical prognostic risk factors of osteonecrosis of femoral head.

目的探讨影响股骨头坏死临床疗效及预后的危险因素。方法对股骨头坏死患者42例57髋行髓芯减压加植骨治疗,其中FicatⅠ期10髋,Ⅱ期29髋,Ⅲ期18髋。对影响股骨头坏死进展的可能因素:年龄、性别、病因、坏死体积、坏死部位进行Cox回归分析,得出影响股骨头进展的影响因素。比较未进展者与进展者坏死体积及坏死部位进展率。绘制坏死体积预测股骨头坏死进展的ROC曲线,计算ROC曲线下面积;取坏死体积约登指数最大时点,作为预测股骨头发生进展的最佳临界点。结果平均随访(32.82±10.82)个月,股骨头进展结果的Cox回归分析表明,坏死体积和坏死部位是影响因素。未进展者的坏死体积明显小于进展者,两者的坏死体积差异有统计学意义(P<0.05)。坏死部位位于外上象限时进展率明显增大(P<0.05)。坏死体积比例预测股骨头坏死进展的最佳临界点为20.15%,大于20.15%时,其预测股骨头坏死进展的敏感度为81.0%,特异度为80.6%,约登指数为0.616。结论股骨头坏死早期治疗预后较好;坏死体积和部位对治疗的进展有影响。坏死体积越大,且坏死部位位于负重区,进展率越高,预后越差。坏死体积比例预测股骨头坏死进展的最佳临界点为20.15%。

Objective To study the prognostic risk factors of osteonecrosis of femoral head（OFN） by MRI scan.Methods Fifty- seven hips of 42 patients with OFN undergoing core decompression with bone graft were included,among which Ficat stage Ⅰ,Ⅱ and Ⅲwere accounted for 10,29 and 18 hips,respectively. Cox regression analysis on age,gender,primary disease,lesion volume and lesion location,was used to predict the risk factors. The lesion volume was compared between progress and no progress groups. The progression rates of different location were also compared. The maximum value of Youden index was selected as the critical point to predict the progression of OFN and to define the sensitivity,specificity and accuracy. Results Patients were followed up for 32. 82 months. Lesion volume and location were predicted to be the risk factors by Cox regression analysis. Significant smaller lesion volume was observed in no progress group. The progression rate of superior lateral quadrant was significantly higher than other quadrants. When the critical value for lesion volume was 20. 15%,the true positive rate was 81. 0% with true negative rate was 80. 6%,and the Youden＇S index was 0. 616. Conclusion Early stage of OFN always has better outcome. Lesion volume and location are predicted to be the risk factors of worse prognosis. Large lesion volume,especially in the superior lateral quadrant,suggests a bad prognosis. The critical value for lesion volume to predict the progression of OFN is 20. 15%.