摘要
目的:探讨非手术保髋治疗国际骨循环研究协会(ARCO)Ⅱ期股骨头坏死(ONFH)的临床疗效及影响因素。方法:前瞻性纳入1996年6月至2017年12月确诊为ARCOⅡ期ONFH并接受非手术保髋治疗(活血通络胶囊+个性化限制性负重)患者75例,男47例,女28例;年龄23~58岁,平均(37.8±11.4)岁;单侧病变52例,双侧病变23例,共98髋;激素性、酒精性、创伤性、特发性ONFH患者分别为42例、22例、2例和9例。收集患者的基线资料及治疗前后的临床和影像学资料,应用ONFH保髋疗效评价体系对临床疗效和影像学表现进行评价。以股骨头塌陷为终点事件,应用受试者工作特征曲线(ROC)分析、Kaplan-Meier生存曲线探究股骨头前侧保留角(APA)、外侧保留角(LPA)与股骨头塌陷的相关性,进一步明确非手术保髋治疗ARCOⅡ期ONFH患者的影响因素。结果:75例全部获得随访,随访时间2.0~21.7年,平均(5.8±3.7)年。治疗后患者的视觉模拟评分(VAS)和临床评分显著低于治疗前(P<0.05);治疗后的影像学评分、股骨头形态评分和骨关节炎评分明显高于治疗前(P<0.05),而坏死面积评分明显低于治疗前(P<0.05)。ROC分析提示APA预测股骨头塌陷的敏感度为78.1%,特异度为86.4%,临界值为61.5°,曲线下面积(AUC)为0.885,95%CI为0.805~0.941,P<0.001;LPA预测股骨头塌陷的敏感度为96.9%,特异度为63.6%,临界值为60.9°,AUC为0.888,95%CI为0.809~0.943,P<0.001;以股骨头塌陷为终点事件,Kaplan-Meier生存曲线分析提示与LPA≤60.9°和APA≤61.5°相比,LPA>60.9°和APA>61.5°的累积生存率更高。多因素Cox回归分析提示治疗前临床评分越高,股骨头塌陷的风险越高,其HR值为1.643,95%CI为1.221~2.212;治疗前APA≤61.5°的股骨头塌陷风险比APA>61.5°高,其HR值为3.77,95%CI为1.553~9.156。结论:非手术保髋可缓解ARCOⅡ期ONFH患者的临床症状,APA>61.5°时可延缓其在影像学上的进展。
Objective:To explore the clinical efficacy and influencing factors of non-operative hip preservation therapy for Association Research Circulation Osseous(ARCO)stageⅡosteonecrisis of the femoral head(ONFH).Methods:Totally 75 patients(98 hips)with ARCO stageⅡONFH treated with non-operative hip preservation therapy were selected in our hospital from June 1996 to December 2017 including 47 males and 28 females with the mean age of(37.8±11.4)years(range,23-58 years)and 52 patients of single hip and 23 patients of both hips.The numbers of patients with hormonal,alcoholic,traumatic and idiopathic ONFH were 42,22,2 and 9.The baseline data of patients were collected,and the clinical and imaging data before and after treatment were reviewed.The clinical and imaging effects were evaluated using ONFH hip preservation efficacy evaluation system.The femoral head collapse was defined as the endpoint.Receiveroperating characteristic curve(ROC)analysis and Kaplan-Meier survival analysis were used to explore the correlation between the anterior preserved angles(APA)and lateral preserved angles(LPA)of the femoral head and collapse,so as to further clarify the influencing factors for non-operative hip protection in the treatment of ONFH patients with ARCO stageⅡ.Results:All patients were followed up for 2.0-21.7 years,with an average of(5.8±3.7)years.Visual analogue scale(VAS)and clinical score were significantly lower after treatment than that before treatment(P<0.05);imaging score,femoral head morphology score and arthritis score after treatment were significantly higher than that before treatment(P<0.05),while necrotic area score was significantly lower(P<0.05).The ROC analysis showed that the sensitivity and specificity of APA prediction on collapse were 78.1%and 86.4%,respectively,and the cut off value was 61.5°[area under curve(AUC):0.885,95%CI:0.805-0.941,P<0.001];the sensitivity,specificity and cut off value of LPA were 96.9%,63.6%and 60.9°,respectively(AUC:0.888,95%CI:0.809-0.943,P<0.001).Considening femoral head collapse as the endpoint,the results of Kaplan-Meier survival analysis showed that compared with LPA≤60.9°and APA≤61.5°,cumulative survival rate was higher with LPA>60.9°and APA>61.5°.Multivariate Cox regression analysis showed that the higher the clinical score before treatment,the higher the risk of collapse,with HR value of 1.643 and 95%CI of 1.221-2.212.Before treatment,the risk of collapse of APA≤61.5°was higher than that of APA>61.5°,with HR value of 3.77 and 95%CI of 1.533-9.156.Conclusions:Non-operative hip preservation therapy can alleviate the clinical symptoms of patients with ARCO stageⅡONFH,and can also delay the progression of the disease on imaging when APA>61.5°.
作者
魏秋实
何晓铭
何伟
张庆文
陈镇秋
何敏聪
林天烨
WEI Qiushi;HE Xiaoming;HE Wei;ZHANG Qingwen;CHEN Zhenqiu;HE Mincong;LIN Tianye(Guangdong Research Institute for Orthopaedics&Traumatology of Chinese Medicine,Guangzhou 510378;Joint Center,Third Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510378;No.3 Orthopaedic Region,First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China)
出处
《中华骨与关节外科杂志》
2022年第6期424-430,共7页
Chinese Journal of Bone and Joint Surgery
基金
国家自然科学基金面上项目(81873327)
国家自然科学基金青年基金项目(82004392)
广东省中医药重点学科建设项目(20220101)
广州中医药大学“双一流”与高水平大学学科协同创新团队重大项目(2021XK05)
广州中医药大学“双一流”与高水平大学学科协同创新团队培育项目(2021XK41、2021XK46)
广东省中医骨伤研究院开放基金课题重点项目(GYH202101-01、GYH202101-04)
广东省中医骨伤研究院开放基金课题一般项目(GYH202102-06)
关键词
股骨头坏死
ACROⅡ期
非手术保髋
疗效评价
影响因素
Osteonecrisis of the Femoral Head
ARCO StageⅡ
Non-operative Hip Preservation
Efficacy Evaluation
Influence Factor
作者简介
通信作者:何伟,E-mail:hw13802516062@163.com
