摘要
目的探讨基于X线的股骨头坏死保髋疗效评价方法。方法收集2004年4月至2010年12月,在中国中医科学院望京医院骨关节科,经髓芯减压病灶清除打压植骨术治疗并获得3年以上随访共41例50髋股骨头坏死患者的X线片,采用基于股骨头形态、坏死面积、骨关节炎X线变化的望京医院X线评价方法(WJXE)进行保髋疗效评价。X线疗效评价指标:(1)股骨头形态:分为4级。0级:股骨头无塌陷;Ⅰ级:股骨头塌陷<2 mm;Ⅱ级:股骨头塌陷2~4 mm;Ⅲ级:股骨头塌陷>4 mm。(2)坏死面积:分为4级。0级:无囊变;Ⅰ级:囊变范围15%以下;Ⅱ级:囊变范围15%~30%之间;Ⅲ级:囊变范围30%以上。(3)骨关节炎:分为5级。0级:无改变;Ⅰ级:轻微骨赘;Ⅱ级:明显骨赘,但未累及关节间隙;Ⅲ级:关节间隙中度变窄;Ⅳ级:关节间隙明显变窄,软骨下骨硬化。X线疗效评价方法:采用分级换算为分值的方法,股骨头形态0~Ⅲ级分别记录为0~3分;坏死面积0~Ⅲ级也记录为0~3分;骨关节炎0~Ⅳ级则分别记录为0~4分。评价结果由形态、面积、骨关节炎3项指标积分相加,最高分为10分,最低分为0分,分值越高,病情越重;反之,病情变轻。不同时间点组间分数的比较采用两个相关样本Willcoxon秩和检验。结果股骨头形态评分治疗前与治疗后3个月(Z=-1.732,P>0.05)差异无统计学意义,而治疗后1年(Z=-3.419,P<0.01)和3年(Z=-3.949,P<0.01)的评分高于治疗前,差异有统计学意义。坏死面积评分在治疗后3个月(Z=0,P<0.01)、1年(Z=-6.245,P<0.01)、3年(Z=-5.423,P<0.01)与治疗前相比明显降低,差异有统计学意义。骨关节炎评分治疗前与治疗后3个月(Z=-1.193,P>0.05)相比差异无统计学意义,治疗后1年(Z=-2.632,P<0.01)和3年(Z=-5.528,P<0.01)的评分也均高于治疗前,差异有统计学意义。结论 WJXE是一种可操作、可重复的股骨头坏死保髋疗效X线评价方法,其实用性、准确性需要在临床进一步验证和推广。
Objective To discuss the efficacy of joint -preserving treatment for osteonecrosis of the femoral head （ONFH） using an X-ray based evaluation approach. Methods The X-ray films of 41 cases （ 50 hips ） with ONFH were collected according to the including criteria. All the patients were treated by the core decompression and focal lesion debridement combining the bone grafting surgery, and followed up for more than three years. The Wangling Hospital X ray evaluation （WJXE） method which was used as indicators for the assessment consisted of two steps. （ 1 ） The first step required quantitation of the following three radiographic findings： femoral head depression; necrosis area and osteoarthritis. Femoral head depression was divided into four levels according to the degree of femoral head depression; necrosis area was divided into four levels according to the cyst area of necrosis; osteoarthritis was divided into five levels. （2） The following scoring system was adopted for evaluation purposes ： the quantization of the three radiographic findings were converted to one score respectively： the maximum point for femoral head depression, necrosis area and osteoarthritis was 0 - 3, 0 - 3 and 0 - 4 points respectively. The sum of the three points generated a single score of 0 - 10 which indicated a more severe condition by the higher score. Willcoxon rank test was applied to compare the score between the different time points. Results There was no statistical difference in the femoral head depression score between the postoperative 3-month data and the one before the treatment （ Z = - 1. 732, P 〉 0. 05 ）, while the scores of postoperative one year （ Z = - 3. 419, P 〈 0.01 ） and three years （ Z = - 3. 949, P 〈 0. 01 ） were higher than the score before the treatment. The necrosis area scores of postoperative 3-month （ Z = 0, P 〈 0. 01 ）, postoperative one year （ Z = - 6. 245, P 〈 0. 01 ） and postoperative three years （ Z = - 5.423, P 〈 0. 01 ） were significantly bett
作者
陈卫衡
Chen Weiheng.(Department of Joint, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China)
出处
《中华关节外科杂志（电子版）》
CAS
2017年第3期4-9,共6页
Chinese Journal of Joint Surgery(Electronic Edition)
基金
"十二五"国家科技支撑计划项目(2015BAI04B03)
关键词
骨坏死
股骨头
X线
评价研究
Osteonecrosis
Femur head
X-rays
Evaluation studies
