The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head.
The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head.
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DOI：
10.1007/s007760200108
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发表时间：
2002-01-01
期刊：
影响因子：
--
通讯作者：
Takaoka, Kunio
中科院分区：
文献类型：
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作者：
Sugano, Nobuhiko;Atsumi, Takashi;Takaoka, Kunio
2001年6月，由日本厚生劳动省主持的特殊疾病调查委员会工作组提出了2001年特发性股骨头坏死诊断、分类和分期的修订标准，以确定特发性股骨头坏死的诊断和治疗标准。选择特异性高的5个诊断标准：股骨头塌陷（包括新月征），x线无关节间隙狭窄或髋臼异常；股骨头分界硬化，无关节间隙狭窄或髋臼异常；骨骼扫描的“冷热交替”；t1加权MRI低强度带（带状图）；组织学上可见小梁和骨髓坏死。如果患者满足这五个标准中的两个，并且没有骨肿瘤或发育不良，则诊断为特发性股骨头骨坏死。根据其在t1加权图像或x线图像上的位置，将坏死病变分为四种类型。A型病变占据内侧三分之一或更少的承重部分。B型病变占据内侧三分之二或更少的承重部分。C1型病变占承重部分的三分之二以上，但不向外侧延伸至髋臼边缘。C2型病变占承重部分的三分之二以上，并向外侧延伸至髋臼边缘。分期是基于x线图像上股骨头的正位和侧位视图。第1阶段定义为x线图像上没有骨坏死的具体表现，尽管在MRI、骨闪烁图或组织学上观察到具体表现。第2阶段是在没有股骨头塌陷的情况下观察到分界性硬化的时期。第3期是股骨头塌陷，包括新月征，未见关节间隙狭窄。在第3期可以观察到股骨头或髋臼形成轻度骨赘。阶段3分为两个子阶段。在3A期，股骨头塌陷小于3mm。在3B期，股骨头塌陷3毫米或更大。第四阶段是观察到骨关节炎变化的时期。
The 2001 revised criteria for the diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head were proposed in June 2001, by the working group of the Specific Disease Investigation Committee under the auspices of the Japanese Ministry of Health, Labor and Welfare, to establish criteria for diagnosis and management of idiopathic osteonecrosis of the femoral head. Five criteria that showed high specificity were selected for diagnosis: collapse of the femoral head (including crescent sign) without joint-space narrowing or acetabular abnormality on x-ray images; demarcating sclerosis in the femoral head without joint-space narrowing or acetabular abnormality; "cold in hot" on bone scans; low-intensity band on T1-weighted MRI (bandlike pattern); and trabecular and marrow necrosis on histology. Idiopathic osteonecrosis of the femoral head is diagnosed if the patient fulfills two of these five criteria and does not have bone tumors or dysplasias. Necrotic lesions are classified into four types, based on their location on T1-weighted images or x-ray images. Type A lesions occupy the medial one-third or less of the weight-bearing portion. Type B lesions occupy the medial two-thirds or less of the weight-bearing portion. Type C1 lesions occupy more than the medial two-thirds of the weight-bearing portion but do not extend laterally to the acetabular edge. Type C2 lesions occupy more than the medial two-thirds of the weight-bearing portion and extend laterally to the acetabular edge. Staging is based on anteroposterior and lateral views of the femoral head on x-ray images. Stage 1 is defined as the period when there are no specific findings of osteonecrosis on x-ray images, although specific findings are observed on MRI, bone scintigram, or histology. Stage 2 is the period when demarcating sclerosis is observed without collapse of the femoral head. Stage 3 is the period when collapse of the femoral head, including crescent sign, is observed without joint-space narrowing. Mild osteophyte formation in the femoral head or acetabulum may be observed in stage 3. Stage 3 is divided into two substages. In stage 3A, collapse of the femoral head is less than 3 mm. In stage 3B, collapse of the femoral head is 3 mm or greater. Stage 4 is the period when osteoarthritic changes are observed.