Prognostic Value of CT Signs and Related Parameters on the Risk of Femoral Head Collapse in Patients with Early Femoral Head Necrosis and Its Relationship with Prognosis
Objective To observe the CT signs of patients with early femoral head necrosis,and analyze the value of CT perfusion parameters in predicting the risk of femoral head collapse and its relationship with prognosis.Methods Ninety-eight patients with early necrosis of femoral head admitted to our hospital from August 2017 to March 2021 were selected.All patients underwent CT examination and CT signs were observed.During 2-year follow-up,femoral head collapse was divided into collapsed group and non-collapsed group according to whether femoral head collapse occurred during the follow-up period.CT parameters of the two groups were compared,and ROC curve was drawn to analyze the value of CT perfusion parameters in predicting femoral head collapse.According to the prognosis during the follow-up period,the patients were divided into good prognosis group and poor prognosis group.By comparing the clinical data and CT parameters of the two groups,a multivariate Logistic regression model was established to analyze the related factors affecting the prognosis of the patients with early femoral head necrosis.Results The CT findings showed that the femoral head was crowded and fused with fan-like sclerosis,trabecular thickening or osteosclerosis in 45 patients,and the articular surface of the femoral head was slightly collapsed,trabecular microfracture,and some subcortical crescent signs in 53 patients.After 2 years of follow-up,34(34.69％)of 98 patients with early femoral head necrosis had femoral head collapse,and 20(20.41％)had poor prognosis.MMT,BV and BF in collapse group were lower than those in non-collapse group(P＜0.05).Drawing ROC curve found that,The AUC of MMT,BV,BF and their combination for predicting femoral head collapse were 0.819(95％CI:0.738-0.900),0.878(95％CI:0.812-0.945),0.873(95％CI:0.807-0.940)and 0.955(95％CI:0.921-0.990);There was no significant difference in gender,age,etiology and necrotic shape between good prognosis group and bad prognosis group(P＞0.05).The Ficat stage,necrotic site ratio in outer upper quadrant and necrotic volume ratio in poor prognosis group were higher than those in good prognosis group,while MMT,BV and BF were lower than those in good prognosis group(P＜0.05).Logistic regression analysis showed that Ficat stage(Ⅲ),necrotic site(upper outer quadrant)and high necrotic volume ratio were independent risk factors affecting the prognosis of patients with early femoral head necrosis(OR＞1,P＜0.05),and the rise of MMT,BV and BF were protective factors(OR＜1,P＜0.05).Conclusion CT can effectively detect early necrosis of femoral head.The main CT signs are osteosclerosis,trabecular thickening and crescent sign,and CT perfusion parameters are closely related to the risk and prognosis of femoral head collapse.
Early Necrosis of Femoral HeadCT SignsCt Perfusion ParametersFemoral Head CollapsePrognosis
NETL
NSTL
万方数据
维普
