病理与计算机两种方法定量测定股骨头坏死病灶的比较
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摘要
目的:比较计算机半自动定量检测软件系统与超薄层病理切片两种方法测量股骨头坏死病灶,为临床治疗方案的选择提供参考。方法:2012年6月至2013年12月,采用人工全髋关节置换术治疗24例单侧晚期(ARCO分期为Ⅲ、Ⅳ期)股骨头缺血性坏死患者,男15例,女9例,年龄33～74(65.1±8.8)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) cm~3,软件测量MRI资料上24髋坏死病灶体积为(20.00±3.04) cm~3,股骨头坏死病灶体积与正常标准股骨头体积比为(42.92±6.09)%,其中占40%以上16髋,30%～40%的8髋,30%以下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) cm~3,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)%,其中占40%以上12髋,30%～40%的11髋,30%以下1髋。计算机软件测量与病理超薄层切片测量,两者股骨头坏死病灶的体积差为(0.113±0.466) cm~3,差异无统计学意义(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>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。
Objective:To compare computer measurement semi automatic quantitative detection software system with ultra thin layer pathological section to confirm the avascular necrosis percentage of the femoral head,and provide reference for clinical treatment options. 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 ±8.8) years old ranging 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 was calculated as a percentage of the whole ball head in both methods. Results:For 24 hips,the normal femoral head volume was(39.58±3.29) cm~3 on average of X-ray film,the necrotic volume was(20.00±3.04) cm~3 on average of MRI by the calculation of computer. The necrotic volume occupying in the volume of the normal femoral head was(42.92±6.09)% on average ranged. The necrotic lesion size was larger than 40% in 16 hips,30% to 40% in 8 hips,1 ess than 30% in 0 hip. Under the pathological section,the necrosis volume was(19.89±3.17) cm~3,the necrotic volume occupying in the volume of the normal femoral head was(40.33±6.36)%. The necrotic lesion size was larger than 40% in 12 hips,30% to 40% in 11 hips,1 ess than30% in 1 hip. In computer and general measurement,the two entire femoral head volume difference was(0.113±0.466) cm~3,there was no significant difference using these measurements(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.
Objective:To compare computer measurement semi automatic quantitative detection software system with ultra thin layer pathological section to confirm the avascular necrosis percentage of the femoral head,and provide reference for clinical treatment options. 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 ±8.8) years old ranging 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 was calculated as a percentage of the whole ball head in both methods. Results:For 24 hips,the normal femoral head volume was(39.58±3.29) cm~3 on average of X-ray film,the necrotic volume was(20.00±3.04) cm~3 on average of MRI by the calculation of computer. The necrotic volume occupying in the volume of the normal femoral head was(42.92±6.09)% on average ranged. The necrotic lesion size was larger than 40% in 16 hips,30% to 40% in 8 hips,1 ess than 30% in 0 hip. Under the pathological section,the necrosis volume was(19.89±3.17) cm~3,the necrotic volume occupying in the volume of the normal femoral head was(40.33±6.36)%. The necrotic lesion size was larger than 40% in 12 hips,30% to 40% in 11 hips,1 ess than30% in 1 hip. In computer and general measurement,the two entire femoral head volume difference was(0.113±0.466) cm~3,there was no significant difference using these measurements(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.
引文
[1]中华医学会骨科分会显微修复学组及中国修复重建外科专业委员会骨缺损及骨坏死学组.成人股骨头坏死诊疗标准专家共识(2012年版)[J].中国骨与关节外科,2012,5(2):185-192.Microscopic Prosthetics Group of Chinese Orthopaedic Medical Association and Bone Defect and Osteonecrosis Group of Reconstruction Surgery Professional Committee of China.Therapeutic Standards on Avascular Necrosis of the Femoral Head to Expert Group(the 2012 edition)[J].Zhongguo Gu Yu Guan Jie Wai Ke,2012,5(2):185-192.Chinese.
[2]李顺东,许世兵,许超,等.基于超薄层切片与计算机辅助识别技术股骨头坏死病灶测量比对研究[J].中国骨伤,2016,29(2):131-135.LI SD,XU SB,XU C,et al.A comparative study on the measurement of femoral head necrosis lesions using ultra-thin layer slicing and computer[J].Zhongguo Gu Shang/China J Orthop Trauma,2016,29(2):131-135.Chinese with abstract in English.
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[4]刘吉鹏,张书钦,陈卫衡.早期股骨头坏死影像表现特点及鉴别诊断[J].中国骨伤,2010,23(5):344-348.LIU JP,ZHANG SQ,CHEN WH.Radiographic imaging feature and differential diagnosis of early femoral head necrosis[J].Zhongguo Gu Shang/China J Orthop Trauma,2010,23(5):344-348.Chinese with abstract in English.
[5]于潼,谢利民,吴飚,等.股骨头坏死MRI及X线片定量诊断的比较研究[J].中国中医骨伤科杂志,2013,21(4):20-23.YU T,XIE LM,WU B,et al.Comparison of MRI and X-ray quantitative diagnosis in femoral head necrosis[J].Zhongguo Zhong Yi Gu Shang Ke Za Zhi,2013,21(4):20-23.Chinese.
[6]郝丽,王琪.MRI征象及定量测量坏死体积对非创伤性股骨头坏死的预测价值[J].中国临床医学影像杂志,2015,26(6):427-431.HAO L,WANG Q.Predictive value of MRI signs and necrosis volume quantitative measurement for non-traumatic osteonecrosis of femoral head[J].Zhongguo Lin Chuang Yi Xue Ying Xiang Za Zhi,2015,26(6):427-431.Chinese.
[7]张萌萌,汝晓双,范鸿禹,等.基于MRI征象与坏死体积测量对非创伤性股骨头坏死塌陷预测价值的初步研究[J].磁共振成像,2017,8(4):296-301.ZHANG MM,RU XS,FAN HY,et al.Prediction of collapse with MRI signs and necrosis volumemeasurement for non-traumatic osteonecrosis of femoral head[J].Ci Gong Zhen Cheng Xiang,2017,8(4):296-301.Chinese.
[8]何海军,陈卫衡,刘洪智,等.股骨头坏死最少层面面积测量法优化研究[J].中国骨伤,2016,29(9):853-858.HE HJ,CHEN WH,LIU HZ,et al.Study on optimization of a fewest layer measuring method of osteonecrotic area in femoral head[J].Zhongguo Gu Shang/China J Orthop Trauma,2016,29(9):853-858.Chinese with abstract in English.
[9]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 reson-ance imaging[J].J Orthop Res,2002,20(1):130-136.
[10]Steinberg DR,Steinberg ME,Garino JP,et al.Determining lesion size in osteonecrosis of the femoral head[J].J Bone Joint Surg Am,2006,88(Suppl 3):27-34.
[2]李顺东,许世兵,许超,等.基于超薄层切片与计算机辅助识别技术股骨头坏死病灶测量比对研究[J].中国骨伤,2016,29(2):131-135.LI SD,XU SB,XU C,et al.A comparative study on the measurement of femoral head necrosis lesions using ultra-thin layer slicing and computer[J].Zhongguo Gu Shang/China J Orthop Trauma,2016,29(2):131-135.Chinese with abstract in English.
[3]鲁超,刘洪智,刘道兵,等.股骨头坏死病灶分布规律探讨[J].中国矫形外科杂志,2014,22(5):396-400.LU C,LIU HZ,LIU DB,et al.Analysis of the lesion distribution in necrosis of the femoral head[J].Zhongguo Jiao Xing Wai Ke Za Zhi,2014,22(5):396-400.Chinese.
[4]刘吉鹏,张书钦,陈卫衡.早期股骨头坏死影像表现特点及鉴别诊断[J].中国骨伤,2010,23(5):344-348.LIU JP,ZHANG SQ,CHEN WH.Radiographic imaging feature and differential diagnosis of early femoral head necrosis[J].Zhongguo Gu Shang/China J Orthop Trauma,2010,23(5):344-348.Chinese with abstract in English.
[5]于潼,谢利民,吴飚,等.股骨头坏死MRI及X线片定量诊断的比较研究[J].中国中医骨伤科杂志,2013,21(4):20-23.YU T,XIE LM,WU B,et al.Comparison of MRI and X-ray quantitative diagnosis in femoral head necrosis[J].Zhongguo Zhong Yi Gu Shang Ke Za Zhi,2013,21(4):20-23.Chinese.
[6]郝丽,王琪.MRI征象及定量测量坏死体积对非创伤性股骨头坏死的预测价值[J].中国临床医学影像杂志,2015,26(6):427-431.HAO L,WANG Q.Predictive value of MRI signs and necrosis volume quantitative measurement for non-traumatic osteonecrosis of femoral head[J].Zhongguo Lin Chuang Yi Xue Ying Xiang Za Zhi,2015,26(6):427-431.Chinese.
[7]张萌萌,汝晓双,范鸿禹,等.基于MRI征象与坏死体积测量对非创伤性股骨头坏死塌陷预测价值的初步研究[J].磁共振成像,2017,8(4):296-301.ZHANG MM,RU XS,FAN HY,et al.Prediction of collapse with MRI signs and necrosis volumemeasurement for non-traumatic osteonecrosis of femoral head[J].Ci Gong Zhen Cheng Xiang,2017,8(4):296-301.Chinese.
[8]何海军,陈卫衡,刘洪智,等.股骨头坏死最少层面面积测量法优化研究[J].中国骨伤,2016,29(9):853-858.HE HJ,CHEN WH,LIU HZ,et al.Study on optimization of a fewest layer measuring method of osteonecrotic area in femoral head[J].Zhongguo Gu Shang/China J Orthop Trauma,2016,29(9):853-858.Chinese with abstract in English.
[9]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 reson-ance imaging[J].J Orthop Res,2002,20(1):130-136.
[10]Steinberg DR,Steinberg ME,Garino JP,et al.Determining lesion size in osteonecrosis of the femoral head[J].J Bone Joint Surg Am,2006,88(Suppl 3):27-34.