目的:探讨股骨头前侧保留角(anterior preserved angle，APA)、外侧保留角(lateral preserved angle，LPA)和联合保留角(combined preserved angle，CPA)在股骨头坏死(osteonecrosis of the femoral head，ONFH)经髋关节外科脱位打压植骨支撑术适应证选择中的作用。方法:以2020年1月至2022年12月在广州中医药大学第三附属医院接受经髋关节外科脱位打压植骨支撑术治疗的ONFH患者为研究对象。收集患者的性别、年龄、ONFH分期和分型，以及手术前后、随访期间双侧髋关节蛙位和正位X线片等信息。在患者术前双侧髋关节蛙位和正位X线片上分别测量股骨头APA和LPA，二角之和为股骨头CPA。以行全髋关节置换术为终点事件，采用Kaplan-Meier法分析经髋关节外科脱位打压植骨支撑术后股骨头生存情况;采用受试者工作特征(receiver operating characteristic，ROC)曲线确定股骨头APA、LPA和CPA预测经髋关节外科脱位打压植骨支撑术治疗失败的最佳临界值，并根据此临界值进行二分类后采用Kaplan-Meier法分析其对股骨头生存情况的预测效果。结果:①一般情况。共纳入109例患者，随访时间 8～47 个月，中位数 25 个月。患者术前股骨头 APA 43。71°±14。43°，LPA 53。08°±15。62°，CPA 96。79°±24。60°。随访期间，18髋改行全髋关节置换术，其中17髋发生在经髋关节外科脱位打压植骨支撑术后2年内。②经髋关节外科脱位打压植骨支撑术后股骨头生存情况。术后1年、2年和3年股骨头生存率分别为97。5％、86。1％和81。6％。③股骨头APA、LPA和CPA对经髋关节外科脱位打压植骨支撑术治疗失败的预测价值评价结果。股骨头APA、LPA和CPA预测经髋关节外科脱位打压植骨支撑术治疗失败的曲线下面积分别为0。835、0。765、0。854，敏感度分别为67。3％、75。2％、91。1％，特异度分别为88。9％、72。2％、72。2％，临界值分别为39。5°、46。5°、75。0°。④股骨头APA、LPA和CPA对经髋关节外科脱位打压植骨支撑术后股骨头生存情况的预测结果。与术前股骨头APA≤39。5°、LPA≤46。5°、CPA≤75。0°相比，术前股骨头APA＞39。5°、LPA＞46。5°、CPA＞75。0°时，股骨头生存率更高。结论:股骨头APA、LPA和CPA可用于指导ONFH经髋关节外科脱位打压植骨支撑术适应证的选择，且术前股骨头APA＞39。5°、LPA＞46。5°、CPA＞75。0°的患者有望获得更好的手术疗效。
The role of anterior,lateral and combined preserved angles of femoral head in the selection of indications for im-paction bone grafting through surgical hip dislocation approach for treating osteonecrosis of the femoral head
Objective:To explore the role of anterior preserved angle(APA),lateral preserved angle(LPA)and combined preserved angle(CPA)of femoral head in the selection of indications for impaction bone grafting through surgical hip dislocation(SHD)approach for treating osteonecrosis of the femoral head(ONFH).Methods:The patients who underwent impaction bone grafting through SHD approach for ONFH in the Third Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2020 to December 2022 were selected as the subjects,and their information,including gender,age,ONFH staging and typing,as well as the X-ray films of bilateral hip joints in normotopia and froglike position before and after the surgery and during follow-up period,was collected.The APA and LPA of the femoral head were measured on the presurgical X-ray films of bilateral hip joints in normotopia and froglike position,respectively,and the sum of the two angles was the CPA of femoral head.With total hip arthroplasty(THA)as the endpoint event,the survival of femoral head after the impaction bone grafting through SHD approach was analyzed by using Kaplan-Meier method.Furthermore,the optimal critical values of APA,LPA and CPA of femoral head in predicting the failure of impaction bone grafting through SHD approach in treating ONFH were deter-mined by using the receiver operating characteristic(ROC)curve.The binary classification was performed on the APA,LPA and CPA of femoral head based on the critical values,and then the Kaplan-Meier method was used to analyze the predictive effects of APA,LPA and CPA of femoral head on the survival of the femoral head.Results:①General condition.One hundred and nine patients were included in the study,and they were followed up for 8-47 months with a median of 25 months.The preoperative femoral head APA,LPA and CPA were 43.71±14.43,53.08±15.62,and 96.79±24.60 degrees,respectively.During the follow-up period,18 hips were re-treated with THA,among which 17 ones experienced a re-operation within 2 years after impaction bone grafting through SHD approach.②The survival of femo-ral head after receiving impaction bone grafting through SHD approach.The results of analysis on the Kaplan-Meier curve showed that,the survival rates of femoral head were 97.5％,86.1％,and 81.6％at postsurgical year 1,2,and 3,respectively.③The results of evaluation on the values of APA,LPA and CPA of femoral head in predicting the failure of impaction bone grafting through SHD approach in treating ONFH.The values of APA,LPA and CPA of femoral head in predicting the failure of impaction bone grafting through SHD approach in trea-ting ONFH was evaluated and analyzed by using ROC curve,and the results showed that the areas under the ROC curves were 0.835,0.765 and 0.854;the sensitivities were 67.3％,75.2％and 91.1％;and the specificities were 88.9％,72.2％,and 72.2％;and the critical val-ues were 39.5,46.5,and 75.0 degrees,respectively.④The prediction results of APA,LPA and CPA of femoral head on the survival of femoral head after receiving impaction bone grafting through SHD approach.Compared to the preoperative femoral head APA ≤39.5 de-grees,LPA ≤46.5 degrees,and CPA ≤75.0 degrees,the survival rate of the femoral head was higher when the preoperative APA,LPA and CPA of femoral head were greater than 39.5,46.5,and 75.0 degrees,respectively.Conclusion:The APA,LPA,and CPA of femoral head can be used to guide the selection of indications for impaction bone grafting through SHD approach in treating ONFH,and the patients with presurgical APA,LPA and CPA of femoral head greater than 39.5,46.5,and 75.0 degrees,respectively,are expected to achieve better sur-gical outcomes.
femur head necrosiship jointdislocationsanterior preserved angle of femoral headlateral preserved angle of femoral headcombined preserved angle of femoral headbone transplantationindication
万方数据
维普
