CAJ | 학술논문

目的探讨应用CT和MR图像测量股骨头缺血坏死(ANFH)病灶体积的可行性和准确性,评价坏死病灶体积在预测股骨头塌陷中的价值.方法将18例因ANFH而行髋关节置换术的25个股骨头的CT、MR图像与大体标本剖面做对照分析,使用移水法测量坏死病灶的体积；用计算机软件分别测量CT和MR图像上坏死病灶的体积,应用单因素方差分析对CT、MRI和大体标本所测得的病灶体积行统计学比较.对行CT扫描确定的未发生股骨头塌陷的62例(92髋)ANFH患者随诊2年,观察是否出现股骨头塌陷,根据观察结果分为塌陷组和非塌陷组,应用t检验对2组的坏死病灶占股骨头体积的百分比行统计学比较,并进行ROC分析.结果 CT、MRI能准确地显示ANFH大体标本上的坏死区、增生反应区和病灶外正常区. CT、MRI和大体标本所测得的坏死病灶体积分别为(20.5±5.2)、(21.4±4.8)和(20.9±5.2)Cm3,三者差异无统计学意义(F=0.185,P=0.831).随访的92髋中57髋出现股骨头塌陷,塌陷组坏死病灶占整个股骨头体积百分比明显高于非塌陷组[(34.5±9.3)％和(23.4±8.4)％；t=5.749,P=0.000],ROC曲线下面积为0.808.结论 ANFH 病灶的体积是影响股骨头塌陷的重要因素,CT和MRI可直观、立体化地显示坏死病灶的形态、位置和准确测量坏死病灶的体积.
목적 탐토응용CT화MR도상측량고골두결혈배사(ANFH)병조체적적가행성화준학성,평개배사병조체적재예측고골두탑함중적개치.방법 장18례인ANFH이행관관절치환술적25개고골두적CT、MR도상여대체표본부면주대조분석,사용이수법측량배사병조적체적；용계산궤연건분별측량CT화MR도상상배사병조적체적,응용단인소방차분석대CT、MRI화대체표본소측득적병조체적행통계학비교.대행CT소묘학정적미발생고골두탑함적62례(92관)ANFH환자수진2년,관찰시부출현고골두탑함,근거관찰결과분위탑함조화비탑함조,응용t검험대2조적배사병조점고골두체적적백분비행통계학비교,병진행ROC분석.결과 CT、MRI능준학지현시ANFH대체 표본상적배사구、증생반응구화병조외정상구. CT、MRI화대체표본소측득적배사병조체적분별위(20.5±5.2)、(21.4±4.8)화(20.9±5.2)Cm3,삼자차이무통계학의의(F=0.185,P=0.831).수방적92관중57관출현고골두탑함,탑함조배사병조점정개고골두체적백분비명현고우비탑함조[(34.5±9.3)％화(23.4±8.4)％；t=5.749,P=0.000],ROC곡선하면적위0.808.결론 ANFH 병조적체적시영향고골두탑함적중요인소,CT화MRI가직관、입체화지현시배사병조적형태、위치화준학측량배사병조적체적.
Objective To investigate the feasibility and accuracy of volumetric measurement of necrotic lesion using CT and MRI,and to assess the value of necrotic lesion volume in predicting collapse of the femoral head in patients with avascular necrosis of the femoral head(ANFH). Methods Comparison among CT,MRI and gross section was performed in 25 femoral heads of 18 patients who underwent total hip replacement for established ANFH.The volume of necrotic lesion was measured using fluid displacement.CT and MRI data were transferred to a computer to calculate the volume of necrotic lesion using software.One way ANOVA was used to compare the volumes of necrotic lesion measured by CT,MRI and gross section.A total of 62 patients (92 hips) who were diagnosed with ANFH but without collapse by CT were followed up 24 months.Student t-test was used to compare the ratio of the volumes of the necrotic lesion and entire femoral head in the hips with and without collapse and ROC curve analysis was carried out.Results CT and MRI coincided with gross section in the necrotic area,proliferative area and extralesional area.The volumes of the necrotic lesion measured by CT,MRI and gross section were ( 20.5 ± 5.2 ),( 21.4 ± 4.8 ),( 20.9 ± 5.2 ) cm3,respectively.There was no significant difference among the necrotic volumes measured by the three methods(F =0.185,P =0.831 ).In fifty-seven out of 92 hips,collapse of the femoral head occurred during the follow-up.The ratio of the volumes of the necrotic lesion and entire femoral head was higher in hips with collapse than in hips without collapse[ (34.5 ±9.3)％ vs.(23.4 ±8.4)％ ;t =5.749,P=0.000].The area under the ROC curve was 0.808. Conclusions The volume of the necrotic lesion plays an important role in the collapse of femoral head in patients with ANFH.Both CT and MRI can identify the shape and location of the necrotic lesion intuitively and stereospecifically and can determine the volume of the necrotic lesion accurately.