CT影像及X线片ABC分型预测股骨头塌陷风险的比较研究

The Comparison of CT and X-ray in Predicting the Risk of Femoral Head Collapse by ABC Classification

目的:应用ABC分型比较CT影像及X线片预测股骨头坏死塌陷风险的一致性,探讨是否可用X线片代替CT影像预测塌陷风险。方法:回顾性分析112例(183髋)ARCOⅡ期及以上非创伤性股骨头坏死病例,应用ABC分型分别对比分析X线片和CT影像预测股骨头坏死塌陷风险,比较二者结果的一致性。结果:183髋病例中142髋发生塌陷(塌陷率为77.60%)。应用CT影像分型,本组病例中A型1髋,B型16髋,C型3髋,AB型22髋,BC型17髋,A-C型124髋。应用X线片分型,本组病例中A型0髋,B型19髋,C型3髋,AB型19髋,BC型21髋,A-C型121髋。二者一致性分析结果为二者一致性良好(ICC系数=0.87,P<0.05)。按照塌陷风险合并后,CT影像分型中无风险3髋,低风险16髋,中风险18髋,高风险146髋;X线片分型中无风险3髋,低风险19髋,中风险21髋,高风险140髋;二者一致性分析结果为差异有统计学意义(Kappa系数=0.76,P<0.05)。结论:ARCOⅡ期及以上股骨头坏死患者X线片可清楚显示坏死边界时,可以选择X线片应用ABC分型方法预测股骨头塌陷风险。

Objective:To compare the consistency between CT and X-ray on the prediction of collapse risk on osteonecrosis of the femoral head(ONFH)by ABC classification,and to explore whether X-ray can be used instead of CT to predict the collapse risk.Methods:A total of 112 cases(183 hips)with non-traumatic ONFH of ARCO stageⅡand above admitted to hospital were retrospectively analyzed.The risk of femoral head necrosis and collapse was predicted by ABC classification in X-ray and CT images respectively.The consistency between the two methods were compared.Results:142 hips in 183 hips had collapsed,with a collapse rate of 77.60%.ABC classification by CT:type A in 1 case,type B in 16 cases,type C in 3 cases,type AB in 22 cases,type BC in 17 cases and type A-C in 124 cases.ABC classification by X-ray:type A in 0 case,type B in 19 cases,type C in 3 cases,type AB in 19 cases,type BC in 21 cases and type A-C in 121 cases.The results of consistency analysis were ICC coefficient=0.87,P<0.05.After combining the cases according to collapse risk,the classification by CT:3 cases were risk-free group,16 cases were low-risk group,18 cases were medium-risk group and 146 cases were high-risk group.The classification by X-ray:3 cases were risk-free group,19 cases were low-risk group,21 cases were medium-risk group and 140 cases were high-risk group.The result of consistency analysis was Kappa coefficient=0.76,P<0.05.Conclusion:When the necrotic border of patients with ONFH with ARCO stageⅡand above can be clearly visualized in X-ray,X-ray can be selected to predict the risk of femoral head collapse using the ABC typing method.