Relationship between the degree of subchondral collapse and articular surface irregularities in osteonecrosis of the femoral head
Relationship between the degree of subchondral collapse and articular surface irregularities in osteonecrosis of the femoral head
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DOI：
10.1002/jor.25539
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发表时间：
2023-03-12
影响因子：
2.8
通讯作者：
Nakashima，Yasuharu
中科院分区：
文献类型：
--
作者：
Yamamoto，Noriko;Motomura，Goro;Nakashima，Yasuharu
关节面不规则常见于股骨头塌陷伴骨坏死，而塌陷程度对关节面的影响尚不清楚。我们首先对76例手术切除的骨坏死股骨头进行了高分辨率显微计算机断层扫描，在2 mm冠状切片上对关节面不规则性进行了宏观评估。在68/76个股骨头中观察到这些不规则性，主要在坏死区域的外侧边界。有关节面不规则的股骨头的平均塌陷程度明显大于无关节面不规则的股骨头（p< 0.0001）。受试者操作特征分析显示，外侧边界关节面不规则的股骨头塌陷程度的截止值为1.1 mm。接下来，对于塌陷<3 mm的股骨头（n= 28），根据自动计数的负曲率点数量定量评估关节面不规则性。定量评价显示塌陷程度与关节面不规则性呈正相关（r= 0.95，p < 0.0001）。8例坏死区以上关节软骨组织学检查显示钙化层细胞坏死，深中层细胞排列异常。总之，坏死股骨头的关节面不规则性取决于塌陷的程度，即使在没有肉眼确定的大体不规则性的情况下，关节软骨也已经改变。
Articular surface irregularities are often observed in collapsed femoral heads with osteonecrosis, while the effects of the degree of collapse on the articular surface are poorly understood. We first macroscopically assessed the articular surface irregularities on 2‐mm coronal slices obtained using high‐resolution microcomputed tomography of 76 surgically resected femoral heads with osteonecrosis. These irregularities were observed in 68/76 femoral heads, mainly at the lateral boundary of the necrotic region. The mean degree of collapse was significantly larger for femoral heads with articular surface irregularities than for those without (p< 0.0001). Receiver operating characteristic analysis showed that the cutoff value for the degree of collapse in femoral heads with articular surface irregularities at the lateral boundary was 1.1 mm. Next, for femoral heads with <3‐mm collapse (n= 28), articular surface irregularities were quantitatively assessed based on the number of automatically counted negative curvature points. Quantitative evaluation showed that the degree of collapse was positively correlated with the presence of articular surface irregularities (r= 0.95,p< 0.0001). Histological examination of articular cartilage above the necrotic region (n= 8) revealed cell necrosis in the calcified layer and abnormal cellular arrangement in the deep and middle layers. In conclusion, articular surface irregularities of the necrotic femoral head depended on the degree of collapse, and articular cartilage was already altered even in the absence of macroscopically determined gross irregularities.