| 股骨头坏死最少层面面积测量法优化研究 |
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Received:June 16, 2016
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| 作者 | Author | 单位 | Unit | E-Mail |
| 何海军 |
HE Hai-jun |
中国中医科学院望京医院关节三科, 北京 100102 |
The Third Department of Arthropathy, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 陈卫衡 |
CHEN Wei-heng |
中国中医科学院望京医院关节三科, 北京 100102 |
The Third Department of Arthropathy, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
drchenweiheng@163.com |
| 刘洪智 |
LIU Hong-zhi |
中国中医科学院望京医院关节三科, 北京 100102 |
The Third Department of Arthropathy, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 李泰贤 |
LI Tai-xian |
中国中医科学院望京医院关节三科, 北京 100102 |
The Third Department of Arthropathy, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 陈志伟 |
CHEN Zhi-wei |
中国中医科学院望京医院关节三科, 北京 100102 |
The Third Department of Arthropathy, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 王均玉 |
WANG Jun-yu |
中国中医科学院望京医院关节三科, 北京 100102 |
The Third Department of Arthropathy, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 刘道兵 |
LIU Dao-bing |
中国中医科学院望京医院关节三科, 北京 100102 |
The Third Department of Arthropathy, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 谢斌 |
XIE Bin |
中国中医科学院望京医院关节三科, 北京 100102 |
The Third Department of Arthropathy, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 王荣田 |
WANG Rong-tian |
中国中医科学院望京医院关节三科, 北京 100102 |
The Third Department of Arthropathy, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 期刊信息：《中国骨伤》2016年29卷，第9期，第853-858页 |
| DOI：10.3969/j.issn.1003-0034.2016.09.016 |
| 基金项目:国家自然科学基金资助项目（编号：81373801）；北京市自然科学基金资助项目（编号：7142170）；北京市科委G20工程支撑保障项目（编号：Z151100003815028） |
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目的：通过MRI多层面坏死面积平均值与坏死体积对照性研究，优化股骨头坏死面积测量方法。
方法：回顾性收集87例（120髋）于2011年1月至2012年1月在中国中医科学院望京医院关节三科确诊为股骨头坏死ARCOⅡ期的患者，采用PHILIPS Achieval 1.5T超导核磁共振仪扫描，选取TSE序列T1WI冠状面的成像作为的测量资料，T1WI上的成像参数均为TSE TR为500ms，TE为20ms，层厚为3.5mm，层距为0.3mm，FOV为374，共扫描12个层面。根据股骨头坏死病灶分布规律，将MRI T1WI冠状位像中显露股骨颈最为完整的正中层面标记为第0层（L0），0层之前由后向前分别顺次标记为第1、2、3、4…层；0层之后由前向后分别顺次标记为第-1、-2、-3、-4…层。采用Auto CAD 2007软件测量所有层面的坏死面积百分比并取其平均值，然后按坏死发生频率由低到高依次减少层数，先减去坏死发生的频率最低的L-3层面，计算余下8个层面的坏死面积平均值，再逐层减去L5、L4、L-2、L-1、L3层面，即分别得出7、6、5、4、3层坏死面积平均值，将这些层面面积平均值分别与MRI坏死体积比值进行比较，最终优化形成最少层面面积测量法。
结果：120髋MRI坏死体积百分比值为0.333±0.151。不同层数坏死面积平均值中，9～3层坏死面积平均值分别为0.321±0.117、0.317±0.136、0.312±0.147、0.333±0.153、0.348±0.172、0.365±0.174、0.377±0.202;其中，当测量层面为9层或依次减少到4层时，其坏死面积平均值与坏死体积百分比值比较差异均无统计学意义（P>0.05），而当测量层面减少到3层时，差异有统计学意义（P<0.05）。采用MRI坏死体积法，120髋ARCO分期标准坏死面积A、B、C 3级分别为12、43、65髋；4层坏死面积平均值法坏死面积A、B、C 3级分别为10、32、78髋，两组间差异无统计学意义（P>0.05），分级结果整体上一致性较高。
结论：4层坏死面积平均值法（L0、L1、L2、L3）与坏死体积测量法差异无统计学意义，是一种相对准确、方便、可行的股骨头坏死最少层面面积测量法，具有一定的临床推广价值。 |
| [关键词]:股骨头坏死 磁共振成像 摄影测量法 髋关节 |
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| Study on optimization of a fewest layer measuring method of osteonecrotic area in femoral head |
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Abstract:
Objective: To optimize a measuring method of osteonecrotic area by analyzing the average osteonecrotic areas and osteonecritic volume using multi-layer MR images.
Methods: The MRI images of 87 cases (120 hips) of ONFH(ARCOⅡ) were collected retrospectively from January 2011 to January 2012 in Wangjing Hospital of China Academy of Chinese Medicine Science. PHILIPS Achieval 1.5T MR was used to obtain coronal TSE T1 weighted (T1W) images. The scanning parameters were shown as follows:slice thickness,3.5 mm; gap,0.3 mm; images repetition time(TR),500 ms;echo time(TE),20 ms;field of view (FOV),374 mm;total 12 layers. According to the distribution rule of osteonecrotic lesion,the layer of coronal T1-weighted imaging showing most of femoral neck was marked as layer 0(L0). The layers before L0 were marked in sequence L1,L2,L3,L4 …,and the layers after L0 were marked in sequence L-1,L-2,L-3,L-4 … Auto CAD 2007 was used to measure the percentage of osteonecrotic area and calcu late the average data,and then decreased the layer from low to high layer successively based on frequency of osteonecrotic occurrences. First,the layer with lowest frequency of osteonecrotic occurrenoses L3 was removed,then calculated the average osteonecrotic area of the ramaining 8 layers. L5,L4,L-2,L-1,L3 layers were gradually removed,resulting in the calculation of avereage osteonecrotic areas in 7,6,5,4,3 layers. These areas were compared to the osteonecrotic volume in MR imagings,leading to the optimization of the fewest layer measuring method of osteonecrotic area using a statistical analysis.
Results: The percentage of osteonecrotic volume in 120 hips was 0.333±0.151. The average osteonecrotic areas of 9 to 3 layers were 0.321±0.117,0.317±0.136,0.312±0.147,0.333±0.153,0.348±0.172,0.365±0.174,0.377±0.202 respectively. There were no statistical differences of the average osteonecrotic areas and osteonecrotic volume in 9 to 3 layers(P>0.05),but when the osteonecrotic layers were reduced to 3,there were statistical differences(P<0.05). Total 120 hips were grouped according to osteonecrotic volume based on ARCO staging criteria,among them,12 hips were grade A,43 were B,65 were C. According to average osteonecrotic areas of 4 layers,10 hips were A grade,32 were B,78 were C. There were no statistical differences between two methods(P>0.05). There was a high degree of concordance among two methods.
Conclusion: The results of 4(L0,L1,L2,L3) layers measuring method and osteonecrotic volume measuring method are similar. The 4 layers measuring method is an accurate,convenient,valuable method measuring the esteonecrotic area with the fewest layers,which is worth to be popularized in clinical application. |
| KEYWORDS:Femur head necrosis Magnetic resonance imaging Photogrametry Hip joint |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 何海军,陈卫衡,刘洪智,李泰贤,陈志伟,王均玉,刘道兵,谢斌,王荣田.股骨头坏死最少层面面积测量法优化研究[J].中国骨伤,2016,29(9):853~858 |
| 英文格式: | HE Hai-jun,CHEN Wei-heng,LIU Hong-zhi,LI Tai-xian,CHEN Zhi-wei,WANG Jun-yu,LIU Dao-bing,XIE Bin,WANG Rong-tian.Study on optimization of a fewest layer measuring method of osteonecrotic area in femoral head[J].zhongguo gu shang / China J Orthop Trauma ,2016,29(9):853~858 |
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