Effects of the location of both anterior and lateral boundaries of the necrotic lesion on collapse progression in osteonecrosis of the femoral head
Effects of the location of both anterior and lateral boundaries of the necrotic lesion on collapse progression in osteonecrosis of the femoral head
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DOI：
10.1016/j.jos.2023.01.011
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发表时间：
2024-03-04
影响因子：
1.7
通讯作者：
Nakashima, Yasuharu
中科院分区：
文献类型：
--
作者：
Utsunomiya, Takeshi;Motomura, Goro;Nakashima, Yasuharu
背景资料：股骨头坏死（ONFH）时，坏死灶外侧边界与髋臼承重部分的位置（分型）是导致塌陷的重要因素。最近的研究还报道了坏死病灶前缘位置对塌陷发生的重要性。我们的目的是评估坏死病灶的前界和侧界位置对ONFH塌陷进展的影响。方法：我们从48例连续患者中招募了55个塌陷后ONFH髋关节，保守随访超过一年。使用平片侧位X线片（Sugioka侧位片），将髋臼承重部分坏死病变的前边界位置分类如下：前区I（2个髋关节）占据内侧三分之一或更少;前区II（17个髋关节）占据内侧三分之二或更少;前区III（36个髋关节）占据内侧三分之二以上。在髋关节疼痛发作时和每个随访期通过双平面X线片测量股骨头塌陷量，并以塌陷进展（>= 1 mm）为终点绘制Kaplan-Meier生存曲线。塌陷进展的概率也通过前区和类型分类的组合进行了评估。结果：55个髋关节中有38个（69.0%）观察到塌陷进展。前区III/C2型髋关节的存活率明显较低。在B/C1型髋关节中，前区III型髋关节（21/24髋）比前区I/II型髋关节（3/17髋，P < 0.0001）更容易发生塌陷进展。结论：在类型分类中增加坏死病灶前边界的位置有助于预测塌陷进展，尤其是B/C1型髋关节。(c)2023年日本正骨协会。Elsevier B. V.出版，保留所有权利。
Background: The location of the lateral boundary of the necrotic lesion to the weight-bearing portion of the acetabulum (Type classification) is an important factor for collapse in osteonecrosis of the femoral head (ONFH). Recent studies also reported the significance of the location of the anterior boundary of the necrotic lesion on the occurrence of collapse. We aimed to assess the effects of the location of both anterior and lateral boundaries of the necrotic lesion on collapse progression in ONFH. Methods: We recruited 55 hips with post-collapse ONFH from 48 consecutive patients, who were conservatively followed for more than one year. Using a plain lateral radiograph (Sugioka's lateral view), the location of the anterior boundary of the necrotic lesion to the weight-bearing portion of the acetabulum was classified as follows: Anterior-area I (two hips) occupying the medial one-third or less; Anterior-area II (17 hips) occupying the medial two-thirds or less; and Anterior-area III (36 hips) occupying greater than the medial two-thirds. The amount of femoral head collapse was measured by biplane radiographs at the onset of hip pain and each follow-up period, and Kaplan-Meier survival curves with collapse progression (>= 1 mm) as the endpoint were produced. The probability of collapse progression was also assessed by the combination of Anterior-area and Type classifications. Results: Collapse progression was observed in 38 of the 55 hips (69.0%). The survival rate of hips with Anterior-area III/Type C2 was significantly lower. Among hips with Type B/C1, collapse progression occurred more frequently in hips with Anterior-area III (21 of 24 hips) than in hips with Anterior-area I/II (3 of 17 hips, P < 0.0001). Conclusions: Adding the location of the anterior boundary of the necrotic lesion to Type classification was useful to predict collapse progression especially in hips with Type B/C1. (c) 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.