| 早期股骨头坏死塌陷风险预测评估体系的临床研究 |
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投稿时间：2020-06-05
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| 作者 | Author | 单位 | Address | E-Mail |
| 于潼 |
YU Tong |
中国中医科学院广安门医院, 北京 100053 |
Department of Orthopaedics, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China |
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| 谢利民 |
XIE Li-min |
中国中医科学院广安门医院, 北京 100053 |
Department of Orthopaedics, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China |
drxlm@126.com |
| 张振南 |
ZHANG Zhen-nan |
中国中医科学院广安门医院, 北京 100053 |
Department of Orthopaedics, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China |
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| 李玉彬 |
LI Yu-bin |
中国中医科学院广安门医院, 北京 100053 |
Department of Orthopaedics, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China |
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| 白杨 |
BAI Yang |
中国中医科学院广安门医院, 北京 100053 |
Department of Orthopaedics, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China |
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| 期刊信息：《中国骨伤》2021年，第34卷，第7期，第617-622页 |
| DOI：10.12200/j.issn.1003-0034.2021.07.006 |
| 基金项目:中国中医科学院自主选题（编号：ZZ0908008）；中国中医科学院广安门医院科研基金课题（编号：2018 S413） |
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中文摘要:
目的：建立早期股骨头坏死塌陷风险评估预测体系，预测评估塌陷风险。
方法：结合Steinberg分期、力学承载的ABC分型和近端硬化带比例建立早期股骨头坏死塌陷风险评估体系，首先应用Steinberg分期系统分期，Ⅰ期应用ABC分型预测风险，C型无风险，B型为低风险型，A型和BC型为中风险型，A-C和AB型为高风险型。SteinbergⅡ-Ⅲ分期首先进行硬化带分型，若为2型直接预测为低风险型；若为1型，则进一步进行ABC分型的划分，预测C型为无风险，B型为低风险型，A型和BC型为中风险型，A-C和AB型为高风险型。依据此预测体系应用回顾性分析的方法，预测由中国中医科学院广安门医院骨科门诊收集的188例（301髋）股骨头病例塌陷风险。并对3名医生及1名医生前后不同时间应用该体系预测结果的一致性进行评价。
结果：188例（301髋）股骨头坏死病例。其中男136例，女52例；年龄19~64（42.61±12.07）岁；单髋75例，双髋113例；病程0.33~5.00（3.62±1.93）年。301髋病例中206髋发生塌陷（塌陷率68.44%）。无风险组，1髋中0髋发生塌陷，塌陷率0%；低风险组，91髋中9髋发生塌陷，塌陷率9.89%；中风险组，19髋中12髋发生塌陷，塌陷率63.16%；高风险组，190髋中185髋发生塌陷，塌陷率97.37%，不同风险组间差异有统计学意义（P=0.00）。该体系预测价值较高（ROC曲线AUC=0.95，P=0.00）。不同医生预测结果一致性良好（ICC=0.94，P=0.00），同一医生前后两次预测结果一致性良好（Kappa系数=0.90，P=0.00）。
结论：早期股骨头坏死风险评估预测体系根据不同时期影像学特点选择不同方法预测塌陷风险，结合多风险因素综合评估，适用范围广泛，操作简捷，便于临床应用。 |
| 【关键词】股骨头坏死 预测体系 塌陷 硬化带 分型 |
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| Clinical study on new risk assessment and prediction system for early osteonecrosis of the femoral head |
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ABSTRACT
Objective: To establish a risk assessment and prediction system for early osteonecrosis of the femoral head(ONFH) in order to predict the collapse risk.
Methods: The risk assessment system for early necrosis and collapse of femoral head was established based on the combination of Steinberg stage,ABC typing and the proportion of the proximal sclerotic rim. Firstly,Steinberg stage system was applied. ABC typing was applied to predict risk in stage I,type C was risk-free,type B was low risk,type A and type BC were medium risk,type A-C and type AB were high risk. The classification of proximal sclerotic rim was first applied when the Steinberg stage was Ⅱ-Ⅲ,and type 2 was expected to be low risk. If the classification of proximal sclerotic rim was type 1,then the ABC typing was applied,type C was risk-free,type B was low risk,type A and type BC were medium risk,type A-C and type AB were high risk. According to this prediction system,the collapse risk of femoral head in 188 cases(301 hips) were predicted by retrospective analysis. All the hips were enrolled at the out-patient department of orthopedic in Guang'anmen Hospital attached to China Academy of Chinese Medical Science. The consistency of the prediction results of three doctors and one doctor at different times were evaluated.
Results: Among them,136 cases were male,52 were female. 75 cases were single hip,113 were double hip. The age of the patients wa 19 to 64(42.61±12.07) years. The natural course of disease was 0.33 to 5.00(3.62±1.93) years. 206 hips in 301 hips had collapsed,with a collapse rate of 68.44%. In the risk-free group,none hip had collapsed,with a collapse rate of 0%. In the low-risk group,9 hip in 91 hips had collapsed,with a collapse rate of 9.89%. In the medium-risk group,12 hip in 19 hips had collapsed,with a collapse rate of 63.16%. And in the high-risk group,185 hips in 190 hips had collapsed,with a collapse rate of 97.37%. They were significantly differences in their collapse rate (P=0.00) in the following order:high-risk group> medium-risk > low-risk group > risk-free group. The prediction value of the system was high (AUC=0.95,P=0.00). The results predicted by different doctors were consistent (ICC=0.94,P=0.00),and the results predicted by the same doctor at two different times were consistent (Kappa coefficient=0.90,P=0.00).
Conclusion: The risk assessment and prediction system for early ONFH selects different methods to predict the risk of collapse according to the imaging characteristics of different stages,which is combines with the comprehensive assessment of multiple risk factors. The system is applicable to a wide range,simple operation and convenient for clinical application. |
| KEY WORDS Femur head necrosis Prediction system Collapse Sclerosis Classification |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 于潼,谢利民,张振南,李玉彬,白杨.早期股骨头坏死塌陷风险预测评估体系的临床研究[J].中国骨伤,2021,34(7):617~622 |
| 英文格式: | YU Tong,XIE Li-min,ZHANG Zhen-nan,LI Yu-bin,BAI Yang.Clinical study on new risk assessment and prediction system for early osteonecrosis of the femoral head[J].zhongguo gu shang / China J Orthop Trauma ,2021,34(7):617~622 |
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