摘要
目的探讨老年无症状股骨头坏死(osteonecrosis of the femoral head, ONFH)患者病情变化情况及危险因素,为治疗该病提供临床依据。方法对湖北省第三人民医院2016年7月~2018年12月收治的192例确诊为一侧ONFH患者进行双侧髋关节核磁共振检查,发现105例患者另一侧无明显症状但核磁共振成像提示存在ONFH,对其进行随访并分析临床资料。采用国际骨微循环研究协会(ARCO)提出的分期标准进行分期,根据无症状侧有无进展情况将入选研究对象分为有进展组(n=38)及无进展组(n=67),对老年无症状ONFH患者分期进展的危险因素使用Logistic回归分析。结果对105例患者进行术后随访,ARCO分期进展38例(36.19%)。通过单因素分析发现,两组患者的病因、坏死区范围、坏死区位置的差异具有统计学意义(P<0.05)。Logistic回归分析数据结果显示激素性病因、坏死区面积占股骨头面积在30%以上、坏死区位于负重区均为患者发生分期进展的独立影响因素(OR=1.17、1.05、1.36,P<0.05)。结论多数老年无症状ONFH患者病情不会进展,病因、坏死位置及坏死范围均为影响ONFH患者病情进展的独立危险因素。
Objective To investigate the changes and risk factors of elderly patients with osteonecrosis of the femoral head(ONFH). Methods Bilateral hip MRI was performed in 192 patients diagnosed with ONFH in one side of our hospital from July 2016 to December 2018, in which 105 patients had no obvious symptoms on the other side, but MRI showed the presence of ONFH. The 105 patients were followed up and the clinical data were analyzed. The staging criteria proposed by the International Bone Microcirculation Research Association(ARCO) were used for staging, and the selected subjects were divided into the progressive group(n=38) and the non-progressive group(n=67) according to the progress of the asymptomatic side, risk factors for staging progression in elderly ONFH patients were analyzed by using Logistic regression. Results Follow-up was performed on 105 patients, 38 cases(36.19%) of ARCO staged. The univariate analysis found that the differences in the etiology, range of necrotic area, and location of necrotic area between the two groups of patients were statistically significant(P<0.05).The results of logistic regression analysis showed that hormonal etiology, the area of necrotic area accounting for more than 30% of the area of femoral head, and the location of necrotic area in the weight-bearing area were all independent influencing factors of staging progress(OR=1.17, 1.05, 1.36, P<0.05). Conclusion Most elderly patients with asymptomatic ONFH do not progress. The etiology, location of necrosis, and extent of necrosis are independent risk factors for the progression of ONFH patients.
作者
陈志华
刘超
李思锐
CHEN Zhi-hua;LIU Chao;LI Si-rui(Department of Orthopedics,The Third People's Hospital of Hubei Province,Wuhan 430033,China;Department of Traumatic Joint Surgery,The Third People's Hospital of Hubei Province,Wuhan 430033,China)
出处
《哈尔滨医科大学学报》
CAS
2021年第3期286-289,共4页
Journal of Harbin Medical University
基金
湖北省自然科学基金资助项目(2017CFB671)。
关键词
股骨头坏死
病情变化
危险因素
老年
necrosis of the femoral head
change of condition
risk factors
old age
