[1]骆聪聪,董一平,袁强,等.股骨头血供参数和平均坏死面积指数与股骨头坏死ARCO分期的相关性分析[J].中医正骨,2024,36(09):36-39,48.
 LUO Congcong,DONG Yiping,YUAN Qiang,et al.Analysing the correlations of femoral head blood supply parameters and mean necrotic area index with ARCO stage of femoral head necrosis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(09):36-39,48.
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股骨头血供参数和平均坏死面积指数与股骨头坏死ARCO分期的相关性分析()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期数:
2024年09期
页码:
36-39,48
栏目:
技术研究
出版日期:
2024-09-20

文章信息/Info

Title:
Analysing the correlations of femoral head blood supply parameters and mean necrotic area index with ARCO stage of femoral head necrosis
作者:
骆聪聪1董一平1袁强1张宁2尤若楠1张颖3
(1.河南中医药大学研究生院,河南 郑州 450046; 2.湖南中医药大学研究生院,湖南 长沙 410208; 3.河南省洛阳正骨医院/河南省骨科医院,河南 洛阳 471002)
Author(s):
LUO Congcong1DONG Yiping1YUAN Qiang1ZHANG Ning2YOU Ruonan1ZHANG Ying3
1.Postgraduate College of Henan University of Chinese Medicine,Zhengzhou 450046,Henan,China 2.Postgraduate College of Hunan University of Chinese Medicine,Changsha 410208,Hunan,China 3.Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China
关键词:
股骨头坏死 股骨头血供 股骨头坏死面积 ARCO分期
Keywords:
femoral head necrosis femoral head blood supply femoral head necrotic area ARCO classification
摘要:
目的:分析股骨头血供参数和平均坏死面积指数与股骨头坏死国际骨微循环研究学会(Association Research Circulation Osseous,ARCO)分期的相关性,为量化评估股骨头血供和坏死程度提供参考。方法:纳入股骨头坏死患者60例(65髋),其中ARCOⅠ期11髋、Ⅱ期23髋、Ⅲ期16髋、Ⅳ期15髋。于患者股骨头血管造影片上测量并计算跨股骨颈的旋股内侧动脉长度与股骨颈直径的比值、后上支持带动脉数量、后下支持带动脉数量等股骨头血供参数,于股骨头轴位MRI T1加权像上测量并计算股骨头平均坏死面积指数。比较不同ARCO分期患髋的股骨头血供参数和平均坏死面积指数,采用Spearman相关分析法分析股骨头血供参数和平均坏死面积指数与股骨头坏死ARCO分期的相关性。结果:不同ARCO分期患髋的跨股骨颈的旋股内侧动脉长度与股骨颈直径的比值、后上支持带动脉数量、后下支持带动脉数量及股骨头平均坏死面积指数的组间差异均有统计学意义(H=16.191,P=0.001; H=31.331,P=0.000; H=13.737,P=0.003; H=12.699,P=0.005)。Spearman相关分析显示,跨股骨颈的旋股内侧动脉长度与股骨颈直径的比值、后上支持带动脉数量、后下支持带动脉数量与股骨头坏死ARCO分期均呈负相关(rs=-0.489,P=0.000; rs=-0.678,P=0.000; rs=-0.456,P=0.000),股骨头平均坏死面积指数与股骨头坏死ARCO分期呈正相关(rs=0.438,P=0.000)。结论:股骨头血供参数与股骨头坏死ARCO分期呈负相关,股骨头平均坏死面积指数与股骨头坏死ARCO分期呈正相关,这些指标对于量化评估股骨头血供和坏死程度具有一定的参考价值。
Abstract:
Objective:To analyze the correlations of femoral head(FH)blood supply parameters and mean necrotic area index(MNAI)with Association Research Circulation Osseous(ARCO)stage of femoral head necrosis(FHN)so as to provide a reference for quantitatively assessing the blood supply and necrotic degree of FH.Methods:Sixty FHN patients(65 hips)were enrolled in the study,with 11 hips in ARCO stageⅠ,23 hips in stageⅡ,16 hips in stageⅢ,and 15 hips in stageⅣ.The FH blood supply parameters,including the ratio of the length of medial femoral circumflex artery(MFCA)across the femoral neck to the diameter of femoral neck,the numbers of posterior superior retinacular artery(SRA)and posterior inferior retinacular artery(IRA),were measured on the angiogram of FH and then calculated.Additionally,the MNAI of FH was measured on the axial MRI T1-weighted image of the FH and then calculated.Furthermore,the FH blood supply parameters and MNAI of the affected hips in the different ARCO stages were compared,and the correlations of FH blood supply parameters and MNAI with the ARCO stage of FHN were analyzed by using Spearman's correlation analysis.Results:The differences were statistically significant in the ratio of the length of MFCA across the femoral neck to the diameter of femoral neck,the numbers of posterior SRA and IRA,MNAI among the hips in different ARCO stages(H=16.191,P=0.001; H=31.331,P=0.000; H=13.737,P=0.003; H=12.699,P=0.005).The results of Spearman correlation analysis revealed that the ratio of the length of MFCA across the femoral neck to the diameter of femoral neck,the numbers of posterior SRA and IRA were all negatively correlated with the ARCO stage of FHN(rs=-0.489,P=0.000; rs=-0.678,P=0.000; rs=-0.456,P=0.000); while,the MNAI of FH was positively correlated with the ARCO stage of FHN(rs=0.438,P=0.000).Conclusion:The FH blood supply parameters are negatively correlated with the ARCO stage of FHN; while,the MNAI is positively correlated with the ARCO stage of FHN.These indicators have a certain reference value for quantitatively assessing the blood supply and necrotic degree of FH.

参考文献/References:

[1] KAMAL D,ALEXANDRU D O,KAMAL C K,et al.Macroscopic and microscopic findings in avascular necrosis of the femoral head[J].Rom J Morphol Embryol,2012,53(3):557-561.
[2] CUI Q,JO W L,KOO K H,et al.ARCO consensus on the pathogenesis of non-traumatic osteonecrosis of the femoral head[J].J Korean Med Sci,2021,36(10):e65.
[3] KO Y S,HA J H,PARK J W,et al.Updating osteonecrosis of the femoral head[J].Hip Pelvis,2023,35(3):147-156.
[4] 赵德伟,范德超.股骨头坏死血供障碍分期在股骨头坏死治疗中的指导意义[J].中华损伤与修复杂志(电子版),2020,15(2):153-155.
[5] ZHAO D,ZHANG F,WANG B,et al.Guidelines for clinical diagnosis and treatment of osteonecrosis of the femoral head in adults(2019 version)[J].J Orthop Translat,2020,21:100-110.
[6] YUE J,GUO X,WANG R,et al.Reliability and repeatability of 2021 ARCO classification and its guiding significance in treatment of nontraumatic osteonecrosis of the femoral head[J].BMC Musculoskelet Disord,2023,24(1):469.
[7] 中国微循环学会骨微循环专业委员会.股骨头坏死临床诊疗技术专家共识(2022年)[J].中国修复重建外科杂志,2022,36(11):1319-1326.
[8] PINILLA-GRACIA C,HERNÁNDEZ-FERNÁNDEZ A,RODRÍGUEZ-NOGUÉ L,et al.Epidemiology,clinical results and success rate in hip preservation surgery in avascular osteonecrosis of the femoral head[J].Acta Ortop Mex,2020,34(1):16-21.
[9] 中华医学会骨科学分会关节外科学组,《中国骨与关节外科》编辑部,《中华关节外科杂志(电子版)》编辑部.股骨头坏死临床诊疗规范(2015年版)[J].中华关节外科杂志(电子版),2015,9(1):133-138.
[10] YOON B H,MONT M A,KOO K H,et al.The 2019 revised version of Association Research Circulation Osseous staging system of osteonecrosis of the femoral head[J].J Arthroplasty,2020,35(4):933-940.
[11] ZHAO D,HUANG S,LU F,et al.Vascularized bone grafting fixed by biodegradable magnesium screw for treating osteonecrosis of the femoral head[J].Biomaterials,2016,81:84-92.
[12] ZHAO K,ZHANG F,QUAN K,et al.Insufficient blood supply of fovea capitis femoris,a risk factor of femoral head osteonecrosis[J].J Orthop Surg Res,2021,16(1):414.
[13] KIM J,LEE S K,KIM J Y,et al.CT and MRI findings beyond the subchondral bone in osteonecrosis of the femoral head to distinguish between ARCO stages 2 and 3A[J].Eur Radiol,2023,33(7):4789-4800.
[14] WANG B,LI L,WANG Y,et al.Digital subtraction angiography and magnetic resonance imaging-based staging of circulatory obstruction in the femoral head during osteonecrosis of the femoral head development[J].Ann Plast Surg,2020,85(6):677-684.
[15] DEWAR D C,LAZARO L E,KLINGER C E,et al.The relative contribution of the medial and lateral femoral circumflex arteries to the vascularity of the head and neck of the femur:a quantitative MRI-based assessment[J].Bone Joint J,2016,98-B(12):1582-1588.
[16] LIU Y,LI M,ZHANG M,et al.Femoral neck fractures:prognosis based on a new classification after superselective angiography[J].J Orthop Sci,2013,18(3):443-450.
[17] ZHENG G S,QIU X,WANG B J,et al.Relationship between blood flow and collapse of nontraumatic osteonecrosis of the femoral head[J].J Bone Joint Surg Am,2022,104(Suppl 2):13-18.
[18] HINES J T,JO W L,CUI Q,et al.Osteonecrosis of the femoral head:an updated review of ARCO on pathogenesis,staging and treatment[J].J Korean Med Sci,2021,36(24):e177.
[19] ZHANG Y,LIU Y W,SUN R B,et al.“Sclerotic Band”type of classification system and measurement of necrotic area for osteonecrosis of the femoral head[J].Medicine(Baltimore),2020,99(36):e22106.
[20] 袁强,林继红,董一平,等.平均坏死面积指数和平均稳定指数与坏死股骨头塌陷进展的相关性分析[J].中国中医骨伤科杂志,2022,30(10):23-27.

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备注/Memo

备注/Memo:
基金项目:国家自然科学基金项目(81774348)
通讯作者:张颖 E-mail:xylrw5@163.com
更新日期/Last Update: 1900-01-01