骨髓水肿与股骨头坏死“带塌陷生存”相关性的X射线评估

Relationship between bone marrow edema and “survival with collapse” of osteonecrosis of the femoral head assessed by X-ray

背景:股骨头坏死塌陷后骨髓水肿广泛存在,骨髓水肿可能是评估股骨头坏死"带塌陷生存"的重要影像学指标。目的:分析股骨头坏死塌陷后骨髓水肿存在情况与股骨头影像学改变的关系,探讨骨髓水肿在股骨头坏死"带塌陷生存"治疗中的意义。方法:病例资料来自于广州中医药大学第一附属医院股骨头坏死专科门诊(2012至2016年),为"广东省优势病种(股骨头坏死)突破项目"登记入组的股骨头坏死非手术治疗患者,对其中60例(81髋)已塌陷的股骨头坏死病例进行随访,其中男43例61髋,女17例20髋,按照改良的骨髓水肿分级(无骨髓水肿、轻度骨髓水肿、重度骨髓水肿)进行分组,其中无骨髓水肿(0级)15髋,轻度骨髓水肿(1级和2级)37髋,重度骨髓水肿(3级)29髋。所有患者对治疗及试验方案均知情同意,且得到医院伦理委员会批准。采用中医药非手术治疗,并指导功能锻炼。每3个月复查双髋关节正蛙位X射线片,观察入组病例在正蛙位塌陷、头臼匹配、关节稳定方面X射线改变,分析骨髓水肿分级对股骨头坏死塌陷后X射线改变的影响。结果与结论:(1)60例(81髋)已塌陷病例随访资料完整,随访时间为4-72个月;(2)经R*C列联表的χ~2检验,不同骨髓水肿分级会全面影响股骨头坏死塌陷后的X射线进展(正蛙位塌陷、头臼匹配、关节稳定),并且差异有显著性意义(P<0.05);(3)提示股骨头坏死塌陷后骨髓水肿广泛存在,骨髓水肿会全面影响塌陷后的X射线改变;骨髓水肿分级越高,正蛙位塌陷、头臼匹配、关节稳定出现X射线进展的概率越大;骨髓水肿是评估股骨头坏死塌陷后治疗的重要影像学指标。

BACKGROUND: Bone marrow edema is commonly seen after the collapse of osteonecrosis of the femoral head, which is may be an important imaging index for assessing the 'survival with collapse' of osteonecrosis of the femoral head.OBJECTIVE: To analyze the relationship between the bone marrow edema after the collapse of osteonecrosis of the femoral head and the changes of femoral head imaging, and to explore the significance of bone marrow edema in the treatment of osteonecrosis of the femoral head of 'survival with collapse'.METHODS: The case data were obtained from the Specialist Department of Osteonecrosis of the Femoral Head at the First Affiliated Hospital of Guangzhou University of Chinese Medicine(2012-2016), who recorded in the non-surgical treatment of osteonecrosis of the femoral head in the 'Guangdong Provincial Dominant Disease(Osteonecrosis of the Femoral Head) Breakthrough Project'. Sixty cases(81 hips) with collapsed osteonecrosis of the femoral head, 43 males with 61 hips and 17 females with 20 hips, were followed up. The patients were grouped according to the improved bone marrow edema grade: no bone marrow edema(grade 0, 15 hips), mild bone marrow edema(grades 1 and 2,37 hips), severe bone marrow edema(grade 3, 29 hips). Informed consents were obtained from all patients, and the study was approved by the Ethics Committee of the hospital. All patients were treated with Chinese medicine, and underwent functional exercise. Frog-leg X-ray films of hip joint were examined every 3 months. The collapse, head-acetabulum match and joint stability on frog-leg X-ray films were observed.The influence of bone marrow edema grade on the X-ray changes after the collapse of osteonecrosis of the femoral head was analyzed.RESULTS AND CONCLUSION:(1) Sixty cases(81 hips) had complete follow-up data. The follow-up time was 4-72 months.(2) By the χ2 test of R*C, different bone marrow edema grades would significantly affect the progress of frog-log X-ray after collapse(collapse,head-acetabulum match, and joint stability)(P < 0.05).(3) In summary, bone marrow edema is widely observed after the collapse of osteonecrosis of the femoral head, and bone marrow edema will fully affect the X-ray changes after collapse. The higher the bone marrow edema grade, the higher the probability of the collapse, head-acetabulum match and joint stability of the frog-leg X-ray films. Bone marrow edema is an important imaging indicator to assess the prognosis of collapse of osteonecrosis of the femoral head.