| 基于病理与计算机两种方法定量测定股骨头坏死病灶百分比的研究 |
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投稿时间：2018-04-01 修订日期：2018-09-02
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| 期刊信息：《中国骨伤》年，第卷，第期，第-页 |
| DOI： |
| 基金项目:1.浙江省科技厅中西医结合骨关节病研究科技创新团队项目(2011R50022-05) 2.浙江省台州市科技项目(162YW11) |
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| 中文摘要:目的 通过计算机半自动定量检测软件系统与超薄层病理切片与两种测量方法，确认股骨头坏死病灶的坏死百分比，为临床治疗方案的选择提供参考。方法 回顾2012年6月至2013年12月，采用人工全髋关节置换术收治的24例单侧晚期（ARCO分期：III期、Ⅳ期）股骨头缺血性坏死患者，男15例，女9例，平均年龄65.1±8.8岁（33～74岁），分析其术前双髋X线片与MRI资料。分别通过术前MRI影像学资料结合计算机半自动定量检测软件系统及术后超薄层病理切片两种方法，量化股骨头坏死病灶的体积，并以X线片测量下计算出的健侧标准股骨头球头体积为参考，计算两种方法下各股骨头坏死区域占整个球头的百分比。结果 X线片上24髋标准股骨头体积为39.58±3.29 cm3（38.19～40.97cm3）。软件测量MRI资料上24髋坏死病灶的体积为20.00±3.04 cm3（18.72～21.29 cm3），股骨头坏死病灶的体积与正常标准股骨头的体积比为42.92％±6.09％（40.35％～45.49％），其中占40％以上的16髋，30％～40％之间的8髋，占30％以下的0髋；大体病理超薄层切片测得24髋股骨头坏死病灶的体积为19.89±3.17 cm3（18.55～21.23 cm3），超薄层切片股骨头坏死病灶的体积与正常标准股骨头的体积比为40.33％±6.36％（37.64％～43.01％），其中占40％以上的12髋，30％～40％之间的11髋，占30％以下的1髋。计算机软件测量与病理超薄层切片测量两种下，两者股骨头坏死病灶的体积差为0.113±0.466cm3(-0.084～0.310 cm3)，在统计学上无显著性差别（t=-1.186，P=0.248）。直线相关分析的结果，计算机软件和大体病理测量股骨头坏死病灶的体积存在正相关（γ=0.980，P=0.000）。结论 股骨头坏死的严重程度与股骨头坏死区域百分比密切相关。当坏死病灶与整体股骨头的坏死百分比大于30％时，患者的临床症状可能趋于加重，行人工全髋关节置换手术治疗的概率明显增加。股骨头坏死百分比对股骨头坏死的分期、预后判断、治疗方案的选择及疗效监测具有重要意义。 |
| 【关键词】股骨头坏死 医学影像学 计算机 病理 百分比 |
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| A Comparative Study about Percentage of femoral head necrosis Based on pathological and Computer |
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| ABSTRACT Objective: Compared the methods between computer aided design software system and ultra-thin layer slicing, and to calculate the Percentage of femoral head necrosis in order to provide reference for clinical treatment. Methods: From June 2012 to December 2013, the X-ray and MRI of 24 patients (24 hips on unilateral ) were reviewed, who had avascular necrosis of the femoral head at late stage (stage III and IV) according to the ARCO international staging system, and performed by total hip arthroplasty. There were 15 males and 9 females , with an average age of (65.1士8.8) years old, ranged 33 to 74 years old. Based on Imaging system combined with computer aided technology (CAD) system and Postoperative ultrathin slice, the volume of the area of femoral head necrosis were calculated. Then combining with the total volume of the femoral head was calculated by X-ray, the percentage of each femoral head necrosis area is calculated as a percentage of the whole ball head in both methods. Results: For 24 hips, on X-ray film, with an average of the normal femoral head volume of (39.58±3.29) cubic centimeter, ranged 38.19 to 40.97 cubic centimeter. By the calculation of computer, with an average necrosis volume of (20.00±3.04) cubic centimeter, ranged 18.72 to 21.29 cubic centimeter. with an average percentage the necrotic volume occupying in the volume of the normal femoral head of (42.92±6.09), ranged 40.35 to 45.49.The necrotic lesion size was larger than 40% in 16 hips, 30% to 40% in 8 hips, 1ess than 30% in 0 hips. Under the pathological section,with an average necrosis volume of (19.89±3.17) cubic centimeter, ranged 18.55 to 21.23 cubic centimeter. with an average percentage the necrotic volume occupying in the volume of the normal femoral head of (40.33±6.36), ranged 37.64 to 43.01.The necrotic lesion size was larger than 40% in 12 hips, 30% to 40% in 11 hips, 1ess than 30% in 1 hip. In computer and general two kinds of measurement, the two entire femoral head volume difference was 0.113±0.466cm3(-0.084～0.310 cm3), there was no significant difference using these measurements(pair t=-1.186，P=0.248). After the linear correlation statistics analysis, there was a positive correlation relationship in necrotic volume between computer software and pathology measurement (γ=0.980, P=0.000). Conclusion: The severity of the necrotic femoral head is closely related to the percentage of necrotic area. When the ratio of necrotic lesions and the whole femoral head is greater than 30%, the patients'' clinical symptoms tend to aggravate, the probability of total hip arthroplasty increased significantly. It have great significances in femoral head necrosis installment, judge the prognosis, guide the selection of treatment and monitoring curative effect. |
| KEY WORDS Avascular necrosis of femoral head,SMedical imaging, Computer, Pathology, Percentage |
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