Clinical significance of different imaging manifestations of osteonecrosis of femoral head in the peri-collapse stage_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WEI Qiushi ^1,2 ,  HE Wei ^1,2 , ZHANG Qingwen ^1,2 , CHEN Zhenqiu ³ , ZHENG Yuesheng ⁴ , LIN Tianye ²

1. Joint Center, Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510378, P.R.China;
2. Guangdong Academy of Traditional Chinese Medicine Orthopedics and Traumatology, Guangzhou Guangdong, 510378, P.R.China;
3. No.3 Department of Orthopectics, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;
4. Department of Orthopectics, Jinshazhou Hospital, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510168, P.R.China;

Corresponding author：

HE Wei, Email: hw13802516062@163.com

Keywords：

Osteonecrosis of the femoral head; peri-collapse stage; radiology; clinical significance

DOI：

10.7507/1002-1892.202103221

Video：

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Objective To explore the different imaging manifestations of osteonecrosis of the femoral head (ONFH) and their correlation with the occurrence of pain during the peri-collapse period.Methods The 372 patients (624 hips) with ONFH in the peri-collapse stage who were admitted between December 2016 and October 2019 and met the selection criteria were selected as the research objects. Among them, there were 270 males and 102 females, with an average age of 35.3 years (mean, 15-65 years). There were 120 cases of unilateral hip and 252 cases of bilateral hips. There were 39 cases (39 hips) of traumatic ONFH, 196 cases (346 hips) of hormonal ONFH, 102 cases (178 hips) of alcoholic ONFH, and 35 cases (61 hips) of idiopathic ONFH. Among them, there were 482 hips with pain symptoms and 142 hips without pain. The pain duration was less than 3 months in 212 hips, 3-6 months in 124 hips, 6-12 months in 117 hips, and more than 12 months in 29 hips. According to the Association Research Circulation Osseous (ARCO) staging, the ONFH was rated as stage Ⅱ in 325 hips and stage Ⅲ in 299 hips. The patients were grouped according to ONFH etiology and ARCO staging, and hip joint pain and X-ray film (crescent sign and cystic changes), CT (subchondral bone fractures and cystic changes), and MRI (bone marrow edema, joint effusion, and subchondral hypointensity zone) were compared. Spearman rank correlation was used to determine the correlation between ONFH pain duration and X-ray film, CT, and MRI imaging manifestations.Results There were significant differences (P<0.05) between ONFH patients with different etiologies in crescent sign on X-ray film, subchondral bone fracture on CT, and joint effusion on MRI. And there were significant differences (P<0.05) between ONFH patients with different ARCO stages in hip pain duration and all imaging manifestations. Correlation analysis showed that the pain duration of ONFH patients was correlated with all imaging manifestations (P<0.05). The cystic change on CT was correlated with the subchondral hypointensity zone and joint effusion grade on MRI, and subchondral hypointensity zone and joint effusion grade on MRI were also correlated (P<0.05).Conclusion The cystic changes, subchondral hypointensity zone, and joint effusion are closely related to the collapse of the femoral head and hip pain in patients with ONFH in the peri-collapse stage. The above-mentioned signals in stage Ⅱ ONFH indicate the instability of the femoral head, which is to predict the development of ONFH and the rational choice of hip-preserving treatment methods provides a basis.

Citation： WEI Qiushi, HE Wei, ZHANG Qingwen, CHEN Zhenqiu, ZHENG Yuesheng, LIN Tianye. Clinical significance of different imaging manifestations of osteonecrosis of femoral head in the peri-collapse stage. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(9): 1105-1110. doi: 10.7507/1002-1892.202103221 Copy

1.	Cui L, Zhuang Q, Lin J, et al. Multicentric epidemiologic study on six thousand three hundred and ninety five cases of femoral head osteonecrosis in China. Int Orthop, 2016, 40(2): 267-276.
2.	Wang W, Zhang N, Guo W, et al. Combined pharmacotherapy for osteonecrosis of the femoral head after severe acute respiratory syndrome and interstitial pneumonia: two and a half to fourteen year follow-up. Int Orthop, 2018, 42(7): 1551-1556.
3.	Yoon BH, Mont MA, Koo KH, et al. The 2019 revised version of association research circulation osseous staging system of osteonecrosis of the femoral head. J Arthroplasty, 2020, 35(4): 933-940.
4.	魏秋实, 庞凤祥, 陈哓俊, 等. 经髋关节外科脱位打压植骨支撑术治疗ARCO Ⅲ期股骨头坏死的临床疗效分析. 中华损伤与修复杂志 (电子版), 2020, 15(2): 90-95.
5.	何伟. 如何把握股骨头坏死患者的保髋治疗时机. 中国骨与关节杂志, 2016, 5(2): 82-86.
6.	魏秋实, 李子祺, 袁颖嘉, 等. “标本兼治” 理论对股骨头坏死中医药治疗的指导作用. 中医正骨, 2020, 32(1): 56-59.
7.	魏秋实, 何伟, 洪志楠, 等. 股骨头坏死MRI脂肪抑制像软骨下低信号带与软骨下骨折的相关性分析. 中国骨与关节损伤杂志, 2020, 35(10): 1009-1012.
8.	Crim J, Layfield LJ, Stensby JD, et al. Comparison of radiographic and pathologic diagnosis of osteonecrosis of the femoral head. AJR Am J Roentgenol, 2021, 216(4): 1014-1021.
9.	Asmus A, Vogel K, Vogel A, et al. Pedicled vascularized iliac bone graft for treatment of osteonecrosis of the femoral head. Oper Orthop Traumatol, 2020, 32(2): 127-138.
10.	Zhang Y, Liu YW, Sun RB, et al. “Sclerotic Band” type of classification system and measurement of necrotic area for osteonecrosis of the femoral head. Medicine (Baltimore), 2020, 99(36): e22106. doi: 10.1097/MD.0000000000022106.
11.	Sonoda K, Yamamoto T, Motomura G, et al. Fat-suppressed T2-weighted MRI appearance of subchondral insufficiency fracture of the femoral head. Skeletal Radiol, 2016, 45(11): 1515-1521.
12.	于潼, 谢利民, 张振南. 影像学预测股骨头坏死塌陷的研究进展. 实用骨科杂志, 2014, 20(5): 430-433.
13.	Huang Z, Tan B, Ye H, et al. Dynamic evolution of osseous structure in osteonecrosis of the femoral head and dynamic collapse risks: a preliminary CT image study. J Orthop Surg Res, 2020, 15(1): 539. doi: 10.1186/s13018-020-02069-8.
14.	Shi S, Luo P, Sun L, et al. Prediction of the progression of femoral head collapse in ARCO stage 2-3A osteonecrosis based on the initial bone resorption lesion. Br J Radiol, 2021, 94(1117): 20200981. doi: 10.1259/bjr.20200981.
15.	李子荣. 股骨头坏死临床诊疗规范. 中国矫形外科杂志, 2016, 24(1): 49-54.
16.	何伟. 精确诊断前提下股骨头坏死非手术治疗实践. 临床外科杂志, 2017, 25(8): 580-582.
17.	赵培荣, 庄奇新, 乔瑞华, 等. 股骨头缺血坏死骨髓水肿的MRI研究. 实用放射学杂志, 2006, 22(7): 835-837.
18.	Mitchell DG, Rao V, Dalinka M, et al. MRI of joint fluid in the normal and ischemic hip. AJR Am J Roentgenol, 1986, 146(6): 1215-1218.
19.	Lau HW, Wong KC, Ho K, et al. Long-term outcome of vascularized iliac bone grafting for osteonecrosis of femoral head: A retrospective study with 17-year follow-up. J Orthop Surg (Hong Kong), 2021, 29(1): 2309499021996842. doi: 10.1177/2309499021996842.
20.	Kubo Y, Motomura G, Ikemura S, et al. The effect of the anterior boundary of necrotic lesion on the occurrence of collapse in osteonecrosis of the femoral head. Int Orthop, 2018, 42(7): 1449-1455.
21.	Kawano K, Motomura G, Ikemura S, et al. Long-term hip survival and factors influencing patient-reported outcomes after transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head: A minimum 10-year follow-up case series. Mod Rheumatol, 2020, 30(1): 184-190.
22.	魏秋实, 方斌, 陈镇秋, 等. 股骨头前外侧骨质状态在股骨头坏死塌陷进展中的作用. 中国组织工程研究, 2019, 23(16): 2516-2522.
23.	Gong SD, Chen XJ, Chen ZQ, et al. Elevated plasma cartilage oligomeric matrix protein (COMP) level are associated with the progression of non-traumatic osteonecrosis of femoral head. Clin Chim Acta, 2019, 490: 214-221.
24.	He MC, Zhang J, Chen XJ, et al. Osteoclastic activity was associated with the development of steroid-induced osteonecrosis of femoral head. Artif Cells Nanomed Biotechnol, 2020, 48(1): 1036-1046.
25.	Ha YC, Jung WH, Kim JR, et al. Prediction of collapse in femoral head osteonecrosis: a modified Kerboul method with use of magnetic resonance images. J Bone Joint Surg (Am), 2006, 88 Suppl 3: 35-40.
26.	杨成彬, 赵萍, 魏秋实, 等. 股骨头坏死保髋术后血管再生的临床研究. 放射学实践, 2020, 35(9): 1181-1185.
27.	Ito H, Matsuno T, Minami A. Relationship between bone marrow edema and development of symptoms in patients with osteonecrosis of the femoral head. AJR Am J Roentgenol, 2006, 186(6): 1761-1770.
28.	Chen XJ, Yang F, Chen ZQ, et al. Association of reduced sclerostin expression with collapse process in patients with osteonecrosis of the femoral head. Int Orthop, 2018, 42(7): 1675-1682.
29.	Hamada H, Takao M, Sakai T, et al. Subchondral fracture begins from the bone resorption area in osteonecrosis of the femoral head: a micro-computerised tomography study. Int Orthop, 2018, 42(7): 1479-1484.
30.	Gao F, Han J, He Z, et al. Radiological analysis of cystic lesion in osteonecrosis of the femoral head. Int Orthop, 2018, 42(7): 1615-1621.
31.	刘光波, 马海洋, 卢强, 等. 股骨头骨坏死囊性变位置分布特征. 解放军医学院学报, 2019, 40(12): 1109-1113, 1137.
32.	Yuan HF, Guo CA, Yan ZQ. The use of bisphosphonate in the treatment of osteonecrosis of the femoral head: a meta-analysis of randomized control trials. Osteoporos Int, 2016, 27(1): 295-299.
33.	王敏, 杨伟民, 李斯明. 股骨头囊性变预测激素性股骨头坏死的临床意义. 中华骨与关节外科杂志, 2019, 12(6): 434-438.
34.	陈敏, 汤彩敬, 许杰雄. 增强MRI检查在诊断早期股骨头坏死中的应用价值. 当代医药论丛, 2017, 15(18): 164-165.
35.	赵德伟, 徐达传, 崔旭. 股骨头不同区域囊变对力学承载的影响. 中华骨科杂志, 2005, 25(4): 232-235.
36.	刘春红, 刘晓红, 刘吉华, 等. 股骨头缺血坏死髋关节腔积液的MRI研究. 临床放射学杂志, 2003, 22(4): 314-316.
37.	Rabquer BJ, Tan GJ, Shaheen PJ, et al. Synovial inflammation in patients with osteonecrosis of the femoral head. Clin Transl Sci, 2009, 2(4): 273-278.

1. Cui L, Zhuang Q, Lin J, et al. Multicentric epidemiologic study on six thousand three hundred and ninety five cases of femoral head osteonecrosis in China. Int Orthop, 2016, 40(2): 267-276.
2. Wang W, Zhang N, Guo W, et al. Combined pharmacotherapy for osteonecrosis of the femoral head after severe acute respiratory syndrome and interstitial pneumonia: two and a half to fourteen year follow-up. Int Orthop, 2018, 42(7): 1551-1556.
3. Yoon BH, Mont MA, Koo KH, et al. The 2019 revised version of association research circulation osseous staging system of osteonecrosis of the femoral head. J Arthroplasty, 2020, 35(4): 933-940.
4. 魏秋实, 庞凤祥, 陈哓俊, 等. 经髋关节外科脱位打压植骨支撑术治疗ARCO Ⅲ期股骨头坏死的临床疗效分析. 中华损伤与修复杂志 (电子版), 2020, 15(2): 90-95.
5. 何伟. 如何把握股骨头坏死患者的保髋治疗时机. 中国骨与关节杂志, 2016, 5(2): 82-86.
6. 魏秋实, 李子祺, 袁颖嘉, 等. “标本兼治” 理论对股骨头坏死中医药治疗的指导作用. 中医正骨, 2020, 32(1): 56-59.
7. 魏秋实, 何伟, 洪志楠, 等. 股骨头坏死MRI脂肪抑制像软骨下低信号带与软骨下骨折的相关性分析. 中国骨与关节损伤杂志, 2020, 35(10): 1009-1012.
8. Crim J, Layfield LJ, Stensby JD, et al. Comparison of radiographic and pathologic diagnosis of osteonecrosis of the femoral head. AJR Am J Roentgenol, 2021, 216(4): 1014-1021.
9. Asmus A, Vogel K, Vogel A, et al. Pedicled vascularized iliac bone graft for treatment of osteonecrosis of the femoral head. Oper Orthop Traumatol, 2020, 32(2): 127-138.
10. Zhang Y, Liu YW, Sun RB, et al. “Sclerotic Band” type of classification system and measurement of necrotic area for osteonecrosis of the femoral head. Medicine (Baltimore), 2020, 99(36): e22106. doi: 10.1097/MD.0000000000022106.
11. Sonoda K, Yamamoto T, Motomura G, et al. Fat-suppressed T2-weighted MRI appearance of subchondral insufficiency fracture of the femoral head. Skeletal Radiol, 2016, 45(11): 1515-1521.
12. 于潼, 谢利民, 张振南. 影像学预测股骨头坏死塌陷的研究进展. 实用骨科杂志, 2014, 20(5): 430-433.
13. Huang Z, Tan B, Ye H, et al. Dynamic evolution of osseous structure in osteonecrosis of the femoral head and dynamic collapse risks: a preliminary CT image study. J Orthop Surg Res, 2020, 15(1): 539. doi: 10.1186/s13018-020-02069-8.
14. Shi S, Luo P, Sun L, et al. Prediction of the progression of femoral head collapse in ARCO stage 2-3A osteonecrosis based on the initial bone resorption lesion. Br J Radiol, 2021, 94(1117): 20200981. doi: 10.1259/bjr.20200981.
15. 李子荣. 股骨头坏死临床诊疗规范. 中国矫形外科杂志, 2016, 24(1): 49-54.
16. 何伟. 精确诊断前提下股骨头坏死非手术治疗实践. 临床外科杂志, 2017, 25(8): 580-582.
17. 赵培荣, 庄奇新, 乔瑞华, 等. 股骨头缺血坏死骨髓水肿的MRI研究. 实用放射学杂志, 2006, 22(7): 835-837.
18. Mitchell DG, Rao V, Dalinka M, et al. MRI of joint fluid in the normal and ischemic hip. AJR Am J Roentgenol, 1986, 146(6): 1215-1218.
19. Lau HW, Wong KC, Ho K, et al. Long-term outcome of vascularized iliac bone grafting for osteonecrosis of femoral head: A retrospective study with 17-year follow-up. J Orthop Surg (Hong Kong), 2021, 29(1): 2309499021996842. doi: 10.1177/2309499021996842.
20. Kubo Y, Motomura G, Ikemura S, et al. The effect of the anterior boundary of necrotic lesion on the occurrence of collapse in osteonecrosis of the femoral head. Int Orthop, 2018, 42(7): 1449-1455.
21. Kawano K, Motomura G, Ikemura S, et al. Long-term hip survival and factors influencing patient-reported outcomes after transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head: A minimum 10-year follow-up case series. Mod Rheumatol, 2020, 30(1): 184-190.
22. 魏秋实, 方斌, 陈镇秋, 等. 股骨头前外侧骨质状态在股骨头坏死塌陷进展中的作用. 中国组织工程研究, 2019, 23(16): 2516-2522.
23. Gong SD, Chen XJ, Chen ZQ, et al. Elevated plasma cartilage oligomeric matrix protein (COMP) level are associated with the progression of non-traumatic osteonecrosis of femoral head. Clin Chim Acta, 2019, 490: 214-221.
24. He MC, Zhang J, Chen XJ, et al. Osteoclastic activity was associated with the development of steroid-induced osteonecrosis of femoral head. Artif Cells Nanomed Biotechnol, 2020, 48(1): 1036-1046.
25. Ha YC, Jung WH, Kim JR, et al. Prediction of collapse in femoral head osteonecrosis: a modified Kerboul method with use of magnetic resonance images. J Bone Joint Surg (Am), 2006, 88 Suppl 3: 35-40.
26. 杨成彬, 赵萍, 魏秋实, 等. 股骨头坏死保髋术后血管再生的临床研究. 放射学实践, 2020, 35(9): 1181-1185.
27. Ito H, Matsuno T, Minami A. Relationship between bone marrow edema and development of symptoms in patients with osteonecrosis of the femoral head. AJR Am J Roentgenol, 2006, 186(6): 1761-1770.
28. Chen XJ, Yang F, Chen ZQ, et al. Association of reduced sclerostin expression with collapse process in patients with osteonecrosis of the femoral head. Int Orthop, 2018, 42(7): 1675-1682.
29. Hamada H, Takao M, Sakai T, et al. Subchondral fracture begins from the bone resorption area in osteonecrosis of the femoral head: a micro-computerised tomography study. Int Orthop, 2018, 42(7): 1479-1484.
30. Gao F, Han J, He Z, et al. Radiological analysis of cystic lesion in osteonecrosis of the femoral head. Int Orthop, 2018, 42(7): 1615-1621.
31. 刘光波, 马海洋, 卢强, 等. 股骨头骨坏死囊性变位置分布特征. 解放军医学院学报, 2019, 40(12): 1109-1113, 1137.
32. Yuan HF, Guo CA, Yan ZQ. The use of bisphosphonate in the treatment of osteonecrosis of the femoral head: a meta-analysis of randomized control trials. Osteoporos Int, 2016, 27(1): 295-299.
33. 王敏, 杨伟民, 李斯明. 股骨头囊性变预测激素性股骨头坏死的临床意义. 中华骨与关节外科杂志, 2019, 12(6): 434-438.
34. 陈敏, 汤彩敬, 许杰雄. 增强MRI检查在诊断早期股骨头坏死中的应用价值. 当代医药论丛, 2017, 15(18): 164-165.
35. 赵德伟, 徐达传, 崔旭. 股骨头不同区域囊变对力学承载的影响. 中华骨科杂志, 2005, 25(4): 232-235.
36. 刘春红, 刘晓红, 刘吉华, 等. 股骨头缺血坏死髋关节腔积液的MRI研究. 临床放射学杂志, 2003, 22(4): 314-316.
37. Rabquer BJ, Tan GJ, Shaheen PJ, et al. Synovial inflammation in patients with osteonecrosis of the femoral head. Clin Transl Sci, 2009, 2(4): 273-278.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical significance of different imaging manifestations of osteonecrosis of femoral head in the peri-collapse stage

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