基于CJFH分型的股骨头坏死三维分型及塌陷预测

Three-dimensional classification and collapse prediction in osteonecrosis of the femoral head based on China-Japan Friendship Hospital classification

背景:研究报道股骨头坏死分型与坏死预后密切相关,基于三柱结构的中日友好医院(China-Japan Friendship Hospital,CJFH)分型对股骨头塌陷的预测准确性高,但其仅局限于二维层面,目前缺少基于此分型建立相应三维分型的研究。目的:通过建立股骨头坏死三柱结构的三维分型,探讨该分型的优势及在股骨头塌陷预测中的价值。方法:选取确诊为股骨头坏死的68例106髋的髋关节MRI和CT资料,基于CJFH分型方法,在三维层面上将股骨头划分为内侧、中央和外侧的三柱结构,并根据坏死区的大小及位置,建立3D-CJFH(Three-dimensional CJFH,3D-CJFH)分型方法。利用这2种分型方法对上述106髋进行分型,得到不同分型的转归。比较3D-CJFH分型和CJFH分型的股骨头坏死塌陷率。结果与结论:(1)3D-CJFH分型分为A型(内侧型),B型(中央型)和C型(外侧型),其中C型包括C1型(次外侧型),C2型(极外侧型)和C3型(全股骨头型);(2)3D-CJFH分型的A、B和C型塌陷率分别为5.6%,8.0%,58.7%;C1、C2和C3的塌陷率分别为25.0%,75.0%,96.3%;CJFH分型的A、B和C型塌陷率分别为5.3%,13.8%,59.3%;C1、C2和C3的塌陷率分别为32.3%,75.0%,95.7%;(3)3D-CJFH分型的A型和C3塌陷率大于CJFH分型,CJFH分型的B型和C1型塌陷率大于3D-CJFH分型,差异均无显著性意义;3D-CJFH分型的C2型塌陷率与CJFH分型相同。3D-CJFH分型的C型塌陷率小于CJFH分型,差异无显著性意义;(4)该研究结果表明,3D-CJFH分型对于股骨头塌陷的预测结果与CJFH分型相似,但3D-CJFH分型更符合股骨头的三维生物力学特性,为股骨头坏死的三维诊断和塌陷精准预测提供了理想的基础。

BACKGROUND： Predictive accuracy of collapse of the femoral head is strongly associated with the classification of osteonecrosis of the femoral head（ONFH）. The China-Japan Friendship Hospital（CJFH） classification of ONFH based on three pillars is sensitive in predicting collapse of the femoral head, but it is only analyzed in two dimensions. There is little reported on the three-dimensional classification based on the CJFH classification.OBJECTIVE： To investigate the advantage of the three-dimensional classification of the three pillars structure and the value of its prediction of collapse in ONFH by establishing the new classification. METHODS： The MRI and CT data of 106 hips（68 cases） diagnosed as ONFH were selected. The femoral head was divided into a medial, central and lateral three-pillars structure three-dimensionally in accordance with the CJFH classification. Three-dimensional CJFH（3 D-CJFH） was established based on the size and location of the necrotic area and the three-dimensional classification. All 106 hips were classified according to 3 D-CJFH classification and CJFH classification, respectively. The collapse rates of the different types were obtained and compared between the two classifications. RESULTS AND CONCLUSION：（1） 3 D-CJFH classification was composed of type A（the medial type）, type B（the central type） and type C（the lateral type）, amongst which the type C consisted of type C1（all pillars were involved with some normal in lateral pillar）, type C2（the whole lateral pillars and partial central pillar） and type C3（the whole femoral head）.（2） The collapse rates of type A（5.6%）, type B（8.0%） and type C（58.7%） of 3 D-CJFH classification were different, and the collapse rates of type C1（25.0%）, type C2（75.0%） and type C3（96.3%） of this classification were also different. Similarly, the collapse rates of type A（5.3%）, type B（13.8%） and type C（59.3%） of CJFH classification were different, and the collapse rates of type C1（32.3%）, type C2（75.0%） and type C3（95.7%） of CJFH classification were also different.（3） The collapse rates of type A and C3 in 3 D-CJFH classification were higher than that in CJFH classification. The collapse rates of type B and C1 in 3 D-CJFH classification were lower than that in 3 D-CJFH classification after comparison. The collapse rate of type C2 in the two classifications revealed no statistically significant difference. The collapse rate of type C in 3 D-CJFH classification was lower compared with that in 3 D-CJFH classification.（4） The results in this study demonstrate that prediction results of femoral head collapse are similar between 3 D-CJFH and CJFH classifications, but the former is more consistent with the 3 D biomechanical properties of femoral head. 3 D-CJFH classification paves ways for three-dimensional diagnosis and prediction of femoral head collapse for necrosis.