Clinical value of MRI parameters related to ischial femoral impingement combined with percentage of necrotic volume in predicting collapse and osteonecrosis of the femoral head
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摘要:
目的 探究磁共振坐骨股骨撞击相关参数[坐骨股骨间隙(IFS)、股方肌间隙(QFS)]联合坏死体积百分比预测股骨头坏死塌陷的临床价值。 方法 选取2013年3月~2022年6月我院收治的股骨头坏死患者67例（81髋），根据股骨头塌陷情况（X线摄片）分为非塌陷组38例（47髋）和塌陷组29例（34髋）。比较两组一般资料、IFS、QFS及各象限和总坏死体积，采用Logistic回归模型研究股骨头坏死塌陷的影响因素，采用Spearman检验进行相关性分析，通过ROC评估IFS、QFS和总坏死体积百分比联合预测股骨头坏死塌陷的价值。 结果 两组年龄、性别、病因差异无统计学意义（P＞0.05），而骨髓水肿、ARCO分期、坏死形态差异有统计学意义（P＜0.05）。与非塌陷组比较，塌陷组IFS、QFS及各象限和总坏死体积增大（P＜0.05），象限PIM坏死体积的差异无统计学意义（P＞0.05）。Logistic回归模型结果显示，ARCO分期Ⅱ期、坏死形态周围型、骨髓水肿、IFS、QFS、总坏死体积百分比为股骨头坏死塌陷的危险因素（P＜0.05）。Spearman检验结果提示，IFS、QFS、总坏死体积百分比均与股骨头坏死塌陷呈正相关关系（P＜0.05）。绘制ROC曲线发现，IFS、QFS和总坏死体积百分比联合预测股骨头坏死塌陷的效能（AUC=0.832）高于各指标单独应用时，其预测敏感度、特异性依次为73.52%、87.22%，临界点依次为16.98 mm、14.65 mm、11.12%。 结论 磁共振坐骨股骨撞击相关参数IFS、QFS联合总坏死体积百分比预测股骨头坏死塌陷的效能较高，有重要的临床应用价值。 Abstract:Objective To explore the clinical value of MRI parameters related to ischial femur impingment [ischial femur space (IFS), quadrate femoral space (QFS)] combined with the percentage of necrosis volume in predicting the collapse and osteonecrosis of the femoral head. Methods Sixty-seven patients (81 hips) with osteonecrosis of the femoral head admitted to our hospital from March 2013 to June 2022 were selected. According to the collapse of the femoral head (X-ray film), the patients were divided into 38 cases (47 hips) in the non-collapse group and 29 cases (34 hips) in the collapse group. General data, IFS, QFS, quadrants and total necrotic volume were compared between the two groups. Logistic regression model was used to study the influencing factors of ONFH and collapse. Spearman test was used for correlation analysis. The combined prediction value of IFS, QFS and percentage of total necrotic volume in the ONFH and collapse was evaluated by ROC curve. Results There were no significant differences in age, gender and etiology between the two groups (P > 0.05), but there were significant differences in bone marrow edema, ARCO stage and necrotic morphology between the two groups (P < 0.05). Compared with the non-collapse group, IFS, QFS, quadrants and total necrotic volume in the collapse group were significantly increased (P < 0.05), but there was no statistical significance in necrotic volume in the PIM quadrant (P > 0.05). Logistic regression model showed that ARCO stage Ⅱ, peripheral necrosis type, bone marrow edema, IFS, QFS and percentage of total necrosis volume were risk factors for femoral head necrosis collapse (P < 0.05). Spearman test indicated that IFS, QFS and percentage of total necrotic volume were positively correlated with necrotic collapse of femoral head (P < 0.05). The ROC curve showed that the combined prediction of IFS, QFS and percentage of total necrosis volume (AUC=0.832) was higher than that of the single application of each index. The prediction sensitivity and specificity were 73.52% and 87.22%, and the critical point were 16.98 mm, 14.65 mm and 11.12%. Conclusion IFS and QFS combined with total necrotic volume percentage of MRI related parameters of ischifemoral impinging have high efficacy in predicting femoral head necrotic collapse. -
图 1 患者MRI图片
A: 男性, 36岁, 激素治疗史, 双侧股骨头缺血坏死, 冠状位T1WI序列左侧股骨头塌陷、碎裂, 左侧股骨头、颈骨髓水肿, 右侧股骨头"双线征"改变; B: 男性, 36岁, 激素治疗史, 横断位T2WI压脂序列左侧股骨头塌陷、碎裂, 左侧股骨头、颈骨髓水肿, 左侧股骨头缺血坏死Ⅳ期, 右侧股骨头Ⅱ期坏死.
Figure 1. MRI features of the patients.
表 1 两组患者一般资料
Table 1. Comparison of general data between the two groups (n)
资料 非塌陷组（47髋） 塌陷组（34髋） χ2/t P 年龄（岁, Mean±SD） 44.21±2.40 44.62±2.17 0.789 0.432 ARCO分期（Ⅰ/Ⅱ期） 28/19 2/32 8.305 0.004 性别（女/男） 12/35 6/28 0.709 0.399 病因（激素/酒精/特发/先髋） 11/13/21/2 7/10/16/1 0.208 0.976 骨髓水肿（无/有） 39/8 8/26 28.627 ＜0.001 坏死形态（中央型/周围型） 41/6 9/25 30.832 ＜0.001 ARCO: 国际骨循环研究协会. 
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表 2 两组IFS、QFS和坏死体积百分比比较
Table 2. Comparison of IFS, QFS and necrosis volume percentage between the two groups (Mean±SD)
指标 非塌陷组（47髋） 塌陷组（34髋） t P IFS (mm) 18.02±3.27 23.36±4.11 6.508 ＜0.001 QFS (mm) 12.22±2.45 16.78±3.09 7.403 ＜0.001 象限ASL坏死体积(%) 32.20±7.41 66.63±15.01 12.332 ＜0.001 象限ASM坏死体积(%) 39.63±9.71 77.74±19.02 10.716 ＜0.001 象限AIL坏死体积(%) 12.21±3.00 28.89±6.94 13.153 ＜0.001 象限AIM坏死体积(%) 14.26±3.49 33.17±8.17 12.684 ＜0.001 象限PSL坏死体积(%) 9.18±2.07 38.20±9.50 17.513 ＜0.001 象限PSM坏死体积(%) 21.19±5.20 53.39±13.20 13.487 ＜0.001 象限PIL坏死体积(%) 2.44±0.48 9.08±2.11 18.015 ＜0.001 象限PIM坏死体积(%) 9.12±2.14 10.03±2.70 1.691 0.090 总坏死体积(%) 17.42±4.23 40.24±9.96 12.565 ＜0.001 IFS: 坐骨股骨间隙; QFS: 股方肌间隙; ASM: 前内上; ASL: 前外上; AIL: 前外下; PSL: 后外上; AIM: 前内下; PSM: 后内上; PIM: 后内下；PIL: 后外下.
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表 3 多因素Logistic回归模型研究股骨头坏死塌陷的影响因素
Table 3. Multifactor Logistic regression model sudy on influential factors of femoral head necrosis and collapse
变量 赋值情况 β SE Wald P OR 95% CI ARCO分期 Ⅰ期=0; Ⅱ期=1 0.732 0.194 12.474 ＜0.001 2.008 1.378~2.810 坏死形态周围型 中央型=0; 周围型=1 0.812 0.223 13.217 ＜0.001 2.252 1.401~3.362 骨髓水肿 无=0; 有=1 0.673 0.183 13.539 ＜0.001 1.961 1.340~2.746 IFS 0.885 0.201 19.420 ＜0.001 2.423 1.784~3.920 QFS 1.055 0.237 19.823 ＜0.001 2.873 2.019~5.113 总坏死体积百分比 1.159 0.332 12.198 0.001 3.187 2.234~8.205
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表 4 ROC相关参数
Table 4. ROC related parameters
参数 临界点 AUC 95% CI P 敏感度（%） 特异性（%） IFS 16.98 0.622 0.501~0.746 0.059 65.31 46.20 QFS 14.65 0.647 0.529~0.771 0.022 55.91 72.30 总坏死体积百分比 11.12 0.719 0.609~0.833 0.001 50.00 79.41 3个指标联合 - 0.832 0.744~0.925 ＜0.001 73.52 87.22
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