Study on the distribution of necrotic tissue in steroid-induced osteonecrosis of femoral head patients based on three-dimensional reconstruction of CT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIANG Xuezhen ¹ , LIU Guangbo ² , LIU Jinbao ¹ , LUO Di ¹ , XU Bo ¹ , PENG Jiang ² ,  LI Gang ¹

1. The First School of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan Shandong, 250355, P.R.China;
2. Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China;

Corresponding author：

LI Gang, Email: sdszylg@163.com

Keywords：

Steroid induced osteonecrosis of femoral head; three-dimensional reconstruction; Mimics software; distribution

DOI：

10.7507/1002-1892.201906065

Video：

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Objective To observe the volume and distribution of necrotic tissue of femoral head in steroid-induced osteonecrosis of femoral head (SONFH) patients by three-dimensional reconstruction of CT.Methods A clinical data of 25 patients with SONFH between September 2016 and December 2018 was analyzed. There were 22 males and 3 females, with an average age of 38.8 years (range, 20-63 years). The necrosis of the femoral head was in stage Ⅱ of Association Research Circulation Osseous (ARCO). The disease duration ranged from 3 to 18 months, with an average of 9.2 months. A three-dimensional reconstruction with CT data of SONFH patients were performed by Mimics Research 21.0 software and the femoral head was segmented into eight regions by 3-matic Research 13.0 software. The volume of necrotic tissue of the femoral head and the volume rate of necrotic tissue to femoral head were calculated and the distribution was also analyzed.Results The three-dimensional digital model of the femoral head showed that the necrotic tissue of the femoral head was located above the anterior superior medial, and the area of the necrotic tissue was in a dome-like shape. The results showed that the necrotic tissue in the femoral head was mainly concentrated on the anterior superior internal area, the anterior superior outer area, and the posterior superior internal area. The volume of femoral head was (48 399.52±9 408.90) mm³, and the volume of necrotic tissue was (20 917.08±6 566.94) mm³, and the volume ratio of necrotic tissue to femoral head was 44.75%±15.72%. The proportion of necrotic volume in different regions was different, and the necrotic tissues were mainly distributed in the anterior superior internal area, the anterior superior outer area, and the posterior superior internal area.Conclusion The volume and distribution of necrotic tissue in femoral head can be evaluated quickly and intuitively by three-dimensional reconstruction of CT in Mimics software.

Citation： LIANG Xuezhen, LIU Guangbo, LIU Jinbao, LUO Di, XU Bo, PENG Jiang, LI Gang. Study on the distribution of necrotic tissue in steroid-induced osteonecrosis of femoral head patients based on three-dimensional reconstruction of CT. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(1): 57-62. doi: 10.7507/1002-1892.201906065 Copy

1.	Pouya F, Kerachian MA. Avascular necrosis of the femoral head: are any genes involved? Arch Bone Jt Surg, 2015, 3(3): 149-155.
2.	魏秋实, 杨帆, 陈哓俊, 等. 激素性与酒精性股骨头坏死患者骨标本坏死区域病理与显微结构特点分析. 中国修复重建外科杂志, 2018, 32(7): 866-872.
3.	Silva LL, Castelar M, Matos MA. Quality of life in pediatric patients with avascular necrosis of the femoral head. Ortop Traumatol Rehabil, 2016, 18(5): 445-449.
4.	Zhao DW, Yu M, Hu K, et al. Prevalence of nontraumatic osteonecrosis of the femoral head and its associated risk factors in the Chinese population: results from a nationally representative survey. Chin Med J (Engl), 2015, 128(21): 2843-2850.
5.	刘宏滨, 赵汉青, 史跃, 等. 股骨头坏死区三维数字化模型建立及体积估算. 中国组织工程研究, 2016, 20(44): 6629-6635.
6.	赵德伟, 谢辉. 成人股骨头坏死保髋手术治疗的策略及探讨. 中国修复重建外科杂志, 2018, 32(7): 792-797.
7.	Gou WL, Lu Q, Wang X, et al. Key pathway to prevent the collapse of femoral head in osteonecrosis. Eur Rev Med Pharmacol Sci, 2015, 19(15): 2766-2774.
8.	郭红斌. CT 和核磁共振诊断股骨头坏死的临床价值对比分析. 实用中西医结合临床, 2017, 17(8): 98-99.
9.	岳栋. CT 与核磁共振诊断股骨头坏死患者临床效果对比分析. 中西医结合心血管病电子杂志, 2017, 5(16): 93-94.
10.	崔洪涛, 李志刚. 探讨 CT 与核磁共振用于股骨头坏死患者诊断中的临床效果. 现代医用影像学, 2016, 25(3): 568-569.
11.	李成录. 探讨股骨头坏死患者 CT 与核磁共振的临床诊断价值. 中外医疗, 2017, 36(7): 183-184.
12.	王文兵. 股骨头坏死患者 CT 与核磁共振诊断的比较研究. 中国 CT 和 MRI 杂志, 2012, 10(6): 102-103.
13.	Hansen BJ, Harris MD, Anderson LA, et al. Correlation between radiographic measures of acetabular morphology with 3D femoral head coverage in patients with acetabular retroversion. Acta Orthop, 2012, 83(3): 233-239.
14.	Van de Velde J, Bogaert S, Vandemaele P, et al. Brachial plexus 3D reconstruction from MRI with dissection validation: a baseline study for clinical applications. Surg Radiol Anat, 2016, 38(2): 229-236.
15.	Yang Z, Guo Z. A three-dimensional digital atlas of the dura mater based on human head MRI. Brain Res, 2015, 1602: 160-167.
16.	Lieberman JR, Engstrom SM, Meneghini RM, et al. Which factors influence preservation of the osteonecrotic femoral head? Clin Orthop Relat Res, 2012, 470(2): 525-534.
17.	Sugano N, Takaoka K, Ohzono K, et al. Prognostication of nontraumatic avascular necrosis of the femoral head. Significance of location and size of the necrotic lesion. Clin Orthop Relat Res, 1994, (303): 155-164.
18.	Sugano N, Ohzono K, Masuhara K, et al. Prognostication of osteonecrosis of the femoral head in patients with systemic lupus erythematosus by magnetic resonance imaging. Clin Orthop Relat Res, 1994, (305): 190-199.
19.	Sugano N, Atsumi T, Ohzono K, et al. The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head. J Orthop Sci, 2002, 7(5): 601-605.
20.	Song WS, Yoo JJ, Kim YM, et al. Results of multiple drilling compared with those of conventional methods of core decompression. Clin Orthop Relat Res, 2007, (454): 139-146.
21.	Malizos KN, Siafakas MS, Fotiadis DI, et al. An MRI-based semiautomated volumetric quantification of hip osteonecrosis. Skeletal Radiol, 2001, 30(12): 686-693.
22.	刘光波, 卢强, 全琦, 等. 股骨头骨坏死塌陷预测研究进展. 解放军医学院学报, 2018, 39(9): 814-818.
23.	Nishii T, Sugano N, Ohzono K, et al. Significance of lesion size and location in the prediction of collapse of osteonecrosis of the femoral head: a new three-dimensional quantification using magnetic resonance imaging. J Orthop Res, 2002, 20(1): 130-136.
24.	Takao M, Sugano N, Nishii T, et al. Longitudinal quantitative evaluation of lesion size change in femoral head osteonecrosis using three-dimensional magnetic resonance imaging and image registration. J Orthop Res, 2006, 24(6): 1231-1239.
25.	Yoon TR, Song EK, Rowe SM, et al. Failure after core decompression in osteonecrosis of the femoral head. Int Orthop, 2001, 24(6): 316-318.
26.	史振才, 李子荣, 孙伟, 等. 计算机处理 MR 图像股骨头坏死体积测定与初步力学测验. 中华放射学杂志, 2006, 40(3): 288-292.
27.	刘予豪, 周驰, 陈雷雷, 等. 基于股骨头坏死围塌陷期理论的保髋术式总结. 中国修复重建外科杂志, 2017, 31(8): 1010-1015.
28.	Hernigou P, Lambotte JC. Volumetric analysis of osteonecrosis of the femur. Anatomical correlation using MRI. J Bone Joint Surg (Br), 2011, 83(5): 672-675.
29.	Bassounas AE, Karantanas AH, Fotiadis DI, et al. Femoral head osteonecrosis: volumetric MRI assessment and outcome. Eur J Radiol, 2007, 63(1): 10-15.

1. Pouya F, Kerachian MA. Avascular necrosis of the femoral head: are any genes involved? Arch Bone Jt Surg, 2015, 3(3): 149-155.
2. 魏秋实, 杨帆, 陈哓俊, 等. 激素性与酒精性股骨头坏死患者骨标本坏死区域病理与显微结构特点分析. 中国修复重建外科杂志, 2018, 32(7): 866-872.
3. Silva LL, Castelar M, Matos MA. Quality of life in pediatric patients with avascular necrosis of the femoral head. Ortop Traumatol Rehabil, 2016, 18(5): 445-449.
4. Zhao DW, Yu M, Hu K, et al. Prevalence of nontraumatic osteonecrosis of the femoral head and its associated risk factors in the Chinese population: results from a nationally representative survey. Chin Med J (Engl), 2015, 128(21): 2843-2850.
5. 刘宏滨, 赵汉青, 史跃, 等. 股骨头坏死区三维数字化模型建立及体积估算. 中国组织工程研究, 2016, 20(44): 6629-6635.
6. 赵德伟, 谢辉. 成人股骨头坏死保髋手术治疗的策略及探讨. 中国修复重建外科杂志, 2018, 32(7): 792-797.
7. Gou WL, Lu Q, Wang X, et al. Key pathway to prevent the collapse of femoral head in osteonecrosis. Eur Rev Med Pharmacol Sci, 2015, 19(15): 2766-2774.
8. 郭红斌. CT 和核磁共振诊断股骨头坏死的临床价值对比分析. 实用中西医结合临床, 2017, 17(8): 98-99.
9. 岳栋. CT 与核磁共振诊断股骨头坏死患者临床效果对比分析. 中西医结合心血管病电子杂志, 2017, 5(16): 93-94.
10. 崔洪涛, 李志刚. 探讨 CT 与核磁共振用于股骨头坏死患者诊断中的临床效果. 现代医用影像学, 2016, 25(3): 568-569.
11. 李成录. 探讨股骨头坏死患者 CT 与核磁共振的临床诊断价值. 中外医疗, 2017, 36(7): 183-184.
12. 王文兵. 股骨头坏死患者 CT 与核磁共振诊断的比较研究. 中国 CT 和 MRI 杂志, 2012, 10(6): 102-103.
13. Hansen BJ, Harris MD, Anderson LA, et al. Correlation between radiographic measures of acetabular morphology with 3D femoral head coverage in patients with acetabular retroversion. Acta Orthop, 2012, 83(3): 233-239.
14. Van de Velde J, Bogaert S, Vandemaele P, et al. Brachial plexus 3D reconstruction from MRI with dissection validation: a baseline study for clinical applications. Surg Radiol Anat, 2016, 38(2): 229-236.
15. Yang Z, Guo Z. A three-dimensional digital atlas of the dura mater based on human head MRI. Brain Res, 2015, 1602: 160-167.
16. Lieberman JR, Engstrom SM, Meneghini RM, et al. Which factors influence preservation of the osteonecrotic femoral head? Clin Orthop Relat Res, 2012, 470(2): 525-534.
17. Sugano N, Takaoka K, Ohzono K, et al. Prognostication of nontraumatic avascular necrosis of the femoral head. Significance of location and size of the necrotic lesion. Clin Orthop Relat Res, 1994, (303): 155-164.
18. Sugano N, Ohzono K, Masuhara K, et al. Prognostication of osteonecrosis of the femoral head in patients with systemic lupus erythematosus by magnetic resonance imaging. Clin Orthop Relat Res, 1994, (305): 190-199.
19. Sugano N, Atsumi T, Ohzono K, et al. The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head. J Orthop Sci, 2002, 7(5): 601-605.
20. Song WS, Yoo JJ, Kim YM, et al. Results of multiple drilling compared with those of conventional methods of core decompression. Clin Orthop Relat Res, 2007, (454): 139-146.
21. Malizos KN, Siafakas MS, Fotiadis DI, et al. An MRI-based semiautomated volumetric quantification of hip osteonecrosis. Skeletal Radiol, 2001, 30(12): 686-693.
22. 刘光波, 卢强, 全琦, 等. 股骨头骨坏死塌陷预测研究进展. 解放军医学院学报, 2018, 39(9): 814-818.
23. Nishii T, Sugano N, Ohzono K, et al. Significance of lesion size and location in the prediction of collapse of osteonecrosis of the femoral head: a new three-dimensional quantification using magnetic resonance imaging. J Orthop Res, 2002, 20(1): 130-136.
24. Takao M, Sugano N, Nishii T, et al. Longitudinal quantitative evaluation of lesion size change in femoral head osteonecrosis using three-dimensional magnetic resonance imaging and image registration. J Orthop Res, 2006, 24(6): 1231-1239.
25. Yoon TR, Song EK, Rowe SM, et al. Failure after core decompression in osteonecrosis of the femoral head. Int Orthop, 2001, 24(6): 316-318.
26. 史振才, 李子荣, 孙伟, 等. 计算机处理 MR 图像股骨头坏死体积测定与初步力学测验. 中华放射学杂志, 2006, 40(3): 288-292.
27. 刘予豪, 周驰, 陈雷雷, 等. 基于股骨头坏死围塌陷期理论的保髋术式总结. 中国修复重建外科杂志, 2017, 31(8): 1010-1015.
28. Hernigou P, Lambotte JC. Volumetric analysis of osteonecrosis of the femur. Anatomical correlation using MRI. J Bone Joint Surg (Br), 2011, 83(5): 672-675.
29. Bassounas AE, Karantanas AH, Fotiadis DI, et al. Femoral head osteonecrosis: volumetric MRI assessment and outcome. Eur J Radiol, 2007, 63(1): 10-15.

Chinese Journal of Reparative and Reconstructive Surgery

Study on the distribution of necrotic tissue in steroid-induced osteonecrosis of femoral head patients based on three-dimensional reconstruction of CT

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