髋关节置换前CT和X射线检查预测坏死股骨头的塌陷:单中心、开放性、诊断性试验

发布时间：2018-02-07 09:00

本文关键词： 组织工程髋关节股骨头坏死骨科植入物人工关节髋关节置换 CT X射线股骨头塌陷预测临床试验　出处：《中国组织工程研究》2017年07期 　论文类型：期刊论文

【摘要】：背景:确定股骨头是否发生塌陷及股骨头关节面软骨的塌陷程度,可帮助骨科医生对股骨头坏死患者选择合理的外科治疗方案。目前中国学者常根据关节面软骨塌陷小于或大于2 mm,作为选择姑息性手术和髋关节置换治疗的依据之一。但目前关于置换前股骨头塌陷的预测研究尚无统一结论。目的:试验假设髋关节置换前采用CT和X射线检查,能对坏死股骨头塌陷情况进行有效预测,其测量结果与术中截除的股骨头标本相比高度匹配。方法:研究为单中心、开放性、诊断性试验,在中国河北省,河北医科大学第三医院完成。选择置换前证实为单侧股骨头坏死并行全髋关节置换患者共86例,实验分3组,采用3种方法均测量股骨头高度变化,X射线组置换前1周采用骨盆正位(髋部健侧及患侧)X射线检查方法测量,CT组置换前1周采用双髋关节(健侧及患侧)CT扫描方法测量,标本组术中截除患侧股骨头标本采用直尺及游标卡尺等测量工具直接测量。试验的主要观察指标为3种方法检测股骨头塌陷的敏感度,次要观察指标为3种方法检测股骨头塌陷的特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比及诊断正确率;X射线及CT检测对股骨头塌陷的诊断一致性分析结果;3种方法检测的股骨头中间、内侧及外侧的高度变化;3种方法观察股骨头形态的变化。试验经中国河北省河北医科大学第三医院伦理委员会批准。研究符合世界医学会制定的《赫尔辛基宣言》的要求。参与者本人对治疗方案和过程均知情同意,并签署知情同意书。讨论:试验以髋关节置换中截除的股骨头标本为基础,结合X射线及CT对股骨头高度数据进行全方位、多角度的测量分析,以期对坏死股骨头塌陷做出准确的预测,并为进一步指导临床医生选择股骨头坏死手术方案提供影像学量化参考依据。
[Abstract]:Background: to determine whether the femoral head collapses and the degree of collapse of articular cartilage of femoral head. It can help orthopedic doctors to select reasonable surgical treatment for patients with osteonecrosis of the femoral head. At present, Chinese scholars often choose palliative surgery and hip replacement treatment according to articular cartilage collapse less than or greater than 2 mm. But there is no uniform conclusion on the prediction of femoral head collapse before replacement. Objective: to assume that CT and X-ray examination were used before hip replacement. It can effectively predict the collapse of the necrotic femoral head, and the measured results are highly matched with the femoral head specimens amputated during the operation. Methods: the study is a single center, open, diagnostic test, in Hebei Province, China. The third Hospital of Hebei Medical University was completed. 86 patients with unilateral femoral head necrosis and total hip replacement were selected and divided into 3 groups. All the three methods were used to measure the height of femoral head. In the X ray group, the pelvic position was measured 1 week before the replacement. The CT scanning method was used to measure the bilateral hip joint (the healthy side and the affected side) 1 week before the replacement. In the specimen group, the specimens of femoral head on the affected side were directly measured by measuring instruments such as straight ruler and Vernier caliper. The main indexes of the experiment were three methods to detect the sensitivity of femoral head collapse. The following indexes were observed: specificity, positive predictive value, negative predictive value, positive likelihood ratio of femoral head collapse. Negative likelihood ratio and diagnostic accuracy the results of the diagnostic consistency analysis of X-ray and CT for the collapse of the femoral head were found in the middle of the femoral head detected by three methods. Three methods were used to observe the changes of femoral head morphology. The experiment was approved by the third Hospital Ethics Committee of Hebei Medical University, Hebei Province, China. The study was in accordance with the Helsinki Declaration formulated by the World Medical Association. The participants themselves have informed consent to the treatment plan and process, The experiment was based on the specimen of femoral head amputated in hip arthroplasty and combined with X-ray and CT to measure and analyze the height of femoral head in all directions and angles. In order to make accurate prediction of necrotic femoral head collapse, and provide imaging quantitative reference basis for further guiding clinicians to choose the plan of femoral head necrosis surgery.
【作者单位】：河北医科大学第三医院骨病科;
【基金】：河北省医学科学研究重点课题计划项目(20150267)~~
【分类号】：R681.8;R816.8

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