Objective: To explore the different imaging manifestations of osteonecrosis of the femoral head (ONFH) and their correlation with the occurrence of pain during the peri-collapse period.
Methods: The 372 patients (624 hips) with ONFH in the peri-collapse stage who were admitted between December 2016 and October 2019 and met the selection criteria were selected as the research objects. Among them, there were 270 males and 102 females, with an average age of 35.3 years (mean, 15-65 years). There were 120 cases of unilateral hip and 252 cases of bilateral hips. There were 39 cases (39 hips) of traumatic ONFH, 196 cases (346 hips) of hormonal ONFH, 102 cases (178 hips) of alcoholic ONFH, and 35 cases (61 hips) of idiopathic ONFH. Among them, there were 482 hips with pain symptoms and 142 hips without pain. The pain duration was less than 3 months in 212 hips, 3-6 months in 124 hips, 6-12 months in 117 hips, and more than 12 months in 29 hips. According to the Association Research Circulation Osseous (ARCO) staging, the ONFH was rated as stage Ⅱ in 325 hips and stage Ⅲ in 299 hips. The patients were grouped according to ONFH etiology and ARCO staging, and hip joint pain and X-ray film (crescent sign and cystic changes), CT (subchondral bone fractures and cystic changes), and MRI (bone marrow edema, joint effusion, and subchondral hypointensity zone) were compared. Spearman rank correlation was used to determine the correlation between ONFH pain duration and X-ray film, CT, and MRI imaging manifestations.
Results: There were significant differences ( P<0.05) between ONFH patients with different etiologies in crescent sign on X-ray film, subchondral bone fracture on CT, and joint effusion on MRI. And there were significant differences ( P<0.05) between ONFH patients with different ARCO stages in hip pain duration and all imaging manifestations. Correlation analysis showed that the pain duration of ONFH patients was correlated with all imaging manifestations ( P<0.05). The cystic change on CT was correlated with the subchondral hypointensity zone and joint effusion grade on MRI, and subchondral hypointensity zone and joint effusion grade on MRI were also correlated ( P<0.05).
Conclusion: The cystic changes, subchondral hypointensity zone, and joint effusion are closely related to the collapse of the femoral head and hip pain in patients with ONFH in the peri-collapse stage. The above-mentioned signals in stage Ⅱ ONFH indicate the instability of the femoral head, which is to predict the development of ONFH and the rational choice of hip-preserving treatment methods provides a basis.
目的: 探讨围塌陷期股骨头坏死（osteonecrosis of the femoral head，ONFH）的影像学表现及与疼痛发生的相关性。.
方法: 以 2016 年 12 月—2019 年 10 月收治且符合选择标准的 372 例（624 髋）围塌陷期 ONFH 患者作为研究对象。其中男 270 例，女 102 例；年龄 15～65 岁，平均 35.3 岁。单髋 120 例，双髋 252 例。ONFH 类型：创伤性 39 例（39 髋）、激素性 196 例（346 髋）、酒精性 102 例（178 髋）、特发性 35 例（61 髋）。其中，有疼痛症状 482 髋，疼痛时间≤3 个月 212 髋、3～6 个月 124 髋、6～12 个月 117 髋、>12 个月 29 髋；无疼痛 142 髋。国际骨循环协会（ARCO）分期：Ⅱ期 325 髋、Ⅲ期 299 髋。将患者根据 ONFH 病因以及 ARCO 分期进行分组，比较髋关节疼痛以及 X 线片（新月征和囊性改变）、CT（软骨下骨骨折和囊性改变）及 MRI（骨髓水肿、关节积液和软骨下低信号带）的影像学表现差异。采用 χ 2 检验分析 ONFH 疼痛时间与 X 线片、CT 及 MRI 影像学表现的相关性。.
结果: 不同病因 ONFH 患者在 X 线片新月征、CT 软骨下骨骨折及 MRI 关节积液方面，差异有统计学意义（ P<0.05）；不同 ARCO 分期 ONFH 患者在髋关节疼痛症状及所有影像学表现方面，差异均有统计学意义（ P<0.05）。相关性分析显示 ONFH 患者疼痛时间与所有影像学表现均相关（ P<0.05）；同时 CT 囊性改变与 MRI 软骨下低信号带、关节积液分级，以及 MRI 软骨下低信号带与关节积液分级亦相关（ P<0.05）。.
结论: 围塌陷期 ONFH 患者影像学上囊性改变、软骨下低信号带、关节积液与股骨头塌陷和髋部疼痛关系密切，当 ARCO Ⅱ期 ONFH 出现上述信号提示股骨头不稳定，为预判 ONFH 疾病发展及合理选择保髋治疗方法提供了依据。.
Keywords: Osteonecrosis of the femoral head; clinical significance; peri-collapse stage; radiology.