MRI联合X线评价生物陶瓷棒植入术治疗早期股骨头坏死的近期疗效

MRI combined with X-ray to evaluate the short-term efficacy of bioceramic rod implantation in the treatment of early osteonecrosis of the femoral head(ONFH)

目的通过磁共振成像(MRI)联合X线对生物陶瓷棒植入术前后影像比较,及时总结经验,指导临床精准选择此类手术的最佳适应证,为临床提供客观的依据。方法选取2017年1月~2018年3月佛山健翔医院收治的早期股骨头无菌性坏死患者30例为研究对象,术前和术后均行双侧髋关节X线及MR检查,各由两位高年资有经验的医师阅片,严格按股骨头坏死国际骨循环研究会(ARCO)分期标准准确分期,以共同意见为准,总结手术适应证及术后股骨头塌陷与否及成骨情况。结果30例患者中评分为优有17例,良有10例,可有2例,差有1例。优良率为90%(27/30)。治疗前患者Harris平均评分为(64.82±3.89)分,治疗后平均评分为(89.85±4.85)分,差异有统计学意义(P<0.05)。30例病例未出现进一步塌陷,股骨头内成骨明显,多孔生物陶瓷与周围骨组织结合较为紧密,关节腔积液明显吸收,髓腔水肿进一步减轻。ARCO分期、坏死形态、骨髓水肿的系数均为负值,为保护因素。预测股骨头坏死塌陷的最佳诊断界值分别为18.86%、48.57%、22.50%。结论MRI联合X线能观察关节腔内积液、髓腔水肿,以及骨旁软组织情况,有利于评估治疗效果;MRI检查和测量在股骨头坏死的定量评价和预测塌陷中具有重要的临床价值,但预测股骨头塌陷时亦应综合考虑各种临床因素(ARCO分期、坏死形态、骨髓水肿)影响,从而进一步提高预测的准确性。

Objective Magnetic resonance imaging(referred to as MRI)combined with X-ray was used to compare the images before and after the bioceramic rod implantation,so as to timely summarize the experience,guide the clinical accurate selection of the optimal indications for such surgery,and provide objective basis for clinical practice.Methods This study selected 30 patients with early aseptic necrosis of the femoral head admitted in the Foshan Jianxiang Hospital from January 2017 to March 2018 as subjects.Preoperative and postoperative X-ray and MR examination of bilateral hip joint were performed,and were read by two senior and experienced physicians,respectively.Accurate staging was conducted in strict accordance with the Association Research Circulation Osseous(ARCO)staging standards for osteonecrosis of the femoral head,and the common opinions were adopted to summarize the surgical indications,whether the femoral head collapsed and the osteogenesis after surgery.Results Among the 30 patients,17 were rated excellent,10 were rated good,2 were rated OK,and 1 was rated poor.The excellent rate was 90%(27/30).The average Harris score of the patients before treatment was(64.82±3.89),and the average score after treatment was(89.85±4.85),with statistically significant difference(P<0.05).There was no further collapse in the 30 cases,with obvious osteogenesis in the femoral head,close combination of porous bioceramics with surrounding bone tissue,obvious absorption of intra-articular effusion,and further alleviation of medullary cavity edema.The coefficients of ARCO staging,necrotic morphology and bone marrow edema were all negative,which were protective factors.The optimal diagnostic cutoffs for predicting osteonecrosis and collapse of the femoral head were 18.86%,48.57% and 22.50%,respectively.Conclusion MRI combined with X-ray can observe the situation of intra-articular effusion,medullary cavity edema,and parosteal soft tissue,which is helpful to evaluate the therapeutic effect;MRI examination and measurement have important clinical value in the quantitative evaluation of osteonecrosis of the femoral head and the prediction of collapse,but various clinical factors(ARCO staging,necrotic morphology and bone marrow edema)should also be taken into comprehensive consideration in the prediction of collapse of the femoral head,so as to further improve the accuracy of prediction.