目的 探讨基于MRI征象及坏死体积百分比预测非创伤性股骨头坏死塌陷的临床应用价值.材料与方法 2010年9月至2012年11月期间连续收集经大连大学附属中山医院门诊或住院检查诊断为非创伤性股骨头坏死且未发生股骨头塌陷的患者共56例(76髋).首次检查及随访均行双侧髋关节X线检查和MRI扫描,并依据每次X线图像判定患者股骨头有无塌陷分为塌陷组(31髋)和非塌陷组(45髋),依据首次MRI分析髋关节骨髓水肿、关节积液、股骨头坏死区部位、形态及信号表现等征象,同时测量股骨头坏死体积和计算股骨头各象限坏死体积百分比.经Logistic回归比较分析,得出危险因素指标;并用受试者工作特征曲线初步确定其敏感度与特异度.结果 本研究中,最终未出现股骨头塌陷者45髋(59.21%),塌陷者31髋(40.79%).两组中除性别、年龄、病因、坏死信号、后内下象限外,其余各指标均有统计学意义(P<0.05).其中发现ARCOⅡ期、周围型坏死、有骨髓水肿、总坏死体积百分比(%)、前外上象限(ASL)与后外上象限(PSL)的坏死体积百分比(%)高者塌陷率更高,并且以外上象限(ASL+PSL)股骨头塌陷更易发生.3种定量指标预测股骨头坏死塌陷的最佳临界值分别为19.51%、47.78%和21.00%,对应的特异度和灵敏度分别为71.1%、68.9%、86.7%和93.5%、83.9%、77.4%.结论 利用MRI检查的征象指标和坏死体积测量可有效提高预测股骨头坏死患者的股骨头塌陷的准确性.%Objective: To investigate the clinical value of prediction of collapse in non-traumatic femoral head necrosis and based on the MRI signs and necrotic volume percentages. Materials and Methods: Fifty-six patients (76 hips) were diagnosed as non-traumatic femoral head necrosis without collapse at affiliated Zhongshan Hospital of Dalian University since September 2010 to November 2012. The X-ray examination and MRI scan were performed at the first time examination and follow-up. According to the X-ray image to determine whether collapse or not, divided into collapse group (31 hips) and non-collapse group (45 hips). The bone marrow edema, joint effusion, location of necrotic lesions necrotic morphology and signal feature was analyzed in MRI of the first time examination, and the each quadrant volume and percentage of the femoral head necrosis was measured. By Logistic regression analysis, the risk factors were concluded, and the sensitivity and specificity was determined by ROC curve (receiver operating characteristic curve). Results: There is no significant difference in routine T1 or T2 weighted imaging between the three group. The ADC values of bilateral midfrontal gyrus and superior temporal gyrus cortex significantly increased in groups Ⅰ and Ⅱ compared to groups Ⅲ (P<0.05). The duration of disease positively correlated with ADC values of the right midfrontal gyrus in group Ⅰ and Ⅱ. Conclusion: The accuracy of prediction of collapse in patients with femoral head necrosis can be effectively improved by using the MRI feature and the measurement of the necrotic volume.
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