成人非创伤性股骨头坏死股骨头塌陷的预测

背景：股骨头坏死塌陷就意味着软骨下骨板的力学性能失效，最终会导致受累的髋关节功能障碍。 目的：测量真实坏死股骨头的坏死体积及坏死体积占整个股骨头体积的百分比，分析股骨头坏死病灶大小和部位与股骨头塌陷的关系。 设计、时间及地点：单一样本观察，于2006-10/2007-10在河北工程大学附属医院解剖教研室完成。 对象：选择河北工程大学附属医院骨科收治的股骨头坏死患者12例15髋，男9例，女3例，年龄41~59岁。 方法：将坏死股骨头用1 mm厚手动钢锯冠状位均匀劈成10等份，将锯开的股骨头放入标有刻度的量杯中，加入生理盐水测量股骨头体积；在每层断面上仔细辨认股骨头坏死反应性增生的硬化带，其内测缘即为股骨头坏死的边界，用尖嘴咬骨钳咬除股骨头坏死部分，然后将去除坏死后的股骨头放入量杯中，加入生理盐水测量股骨头坏死体积。 主要观察指标：①股骨头坏死体积及坏死体积比测量结果。②坏死体积比例与坏死股骨头数目关系。 结果：股骨头劈开后测量整个股骨头的平均体积为50.0 cm3，股骨头坏死区域的平均体积为21.6 cm3，股骨头坏死区域的体积与整个股骨头的体积比平均值为43.5%。股骨头坏死体积比在40%以上的有9髋，30%~40%有4髋，30%以下的有2髋。 结论：坏死病灶的大小与股骨头塌陷的危险性密切相关，当坏死病灶体积大于30%时，股骨头坏死的塌陷率高达87%，具有高风险塌陷；小于30%时，坏死病灶的位置对病情进展起关键作用。

Estimation of femoral head collapse in adult patients with non-traumatic femoral head necrosis

BACKGROUND: Necrosis and collapse of the femoral head imply mechanical loss of bone plate below cartilage, and induces dysfunction of affected hip joint. OBJECTIVE: To measure the ratio of the volume of femoral head necrosis area to the whole femoral head (the ratio of necrosis volume), so as to analyze the relationship between the location and size of the femoral head necrosis and femoral head collapse. DESIGN, TIME AND SETTING: Single sample observation was performed at Department of Anatomy, Hospital of Hebei University of Engineering between October 2006 and October 2007. PARTICIPANTS: Twelve patients with necrosis of the femoral head, 9 males and 3 females, aged 41-59 years, were selected from Department of Orthopedics, Hospital of Hebei University of Engineering. METHODS: The necrosis femoral head was split into 10 pieces of 1 mm thick in uniformity with hacksaw, and put into measuring glass. Normal saline was added to measure the volume of femoral head. The reactive hyperplasia stiffen zone of the femoral head necrosis in every section was identified carefully. The inner margin was the boundary of the femoral head necrosis. The part of femoral head necrosis was bite away by sharp rongeur, and the necrosis femoral head with no necrosis part was put into the measuring glass. Normal saline was added to measure the volume of necrosis femoral head. MAIN OUTCOME MEASURES: Volume of femoral head necrosis and the ratio of the volume of femoral head necrosis area to the whole femoral head; relationship between the location and size of the femoral head necrosis and femoral head collapse. RESULTS: The average volume of the whole femoral head that was measured by split femoral head was 50.0 cm3. The average volume of femoral head necrosis area was 21.6 cm3. The average ratio of the volume of femoral head necrosis area to the whole femoral head was 43.5%. The ratio of necrosis volume of 9 hips was more than 40%, 4 hips between 30% and 40% and 2 hips less than 30%. CONCLUSION: The size of necrosis is closely correlated with the risk of femoral head collapse. When the volume ratio of femoral head necrosis is more than 30%, the rate of femoral head necrosis collapse is 87% and the collapse has high risk. When the volume ratio of femoral head necrosis is less than 30%, the location of collapse focus plays key role in progression of pathogenetic condition.