摘要
[目的]探讨增强MRI灌注指数(perfusion index,PI)评估早期Legg-Calve-Perthes(LCP)病(简称Perthes病)预后的意义。[方法]回顾性分析2016年10月—2019年12月本院诊治的早期Perthes病26例患儿的临床资料;均为单侧病变,初诊时X线改良Waldenström分期Ⅰa期2例、Ⅰb期15例、Ⅱa期9例。所有患儿均通过增强MRI行PI和其他影像指标测量。双下肢外展内旋位石膏固定6~8周后改外展内旋支具继续固定至Ⅲa期,扶拐下地。待股骨头外侧1/3修复后弃拐行走避免体育运动,直至Ⅳ期。[结果]26例患儿中,初诊时PI<25%的患儿6例,占23.1%;初诊时PI≥25%的患儿20例,占76.9%。两组患儿在初诊时年龄、性别构成、病变侧别和初诊Waldenström分期的差异均无统计学意义(P>0.05);此外,两组在最终进入Ⅳ期时干骺端宽度患侧与健侧比值和Ⅳ期关节-大转了距离(articulo-trochanteric distance,ATD)患侧与健侧比值的差异亦无统计学意义(P>0.05)。但是,PI<25%组初诊时PI显著小于PI≥25%组[%,(14.4±4.2)vs(50.3±21.4),P<0.001],PI<25%组进入Ⅲa期的时间显著长于PI≥25%组[年,(1.3±0.2)vs(0.8±0.3),P<0.001],PI<25%Ⅳ期股骨头骺高度患侧与健侧比值显著小于PI≥25%组[%,(58.6±17.0)vs(79.7±12.6),P=0.001],PI<25%组跳过Ⅱb期的比率显著低于PI≥25%组(0 vs 40.0%,P=0.017)。两两相关分析表明:PI与进入Ⅲa期所需时间呈显著负相关(r=-0.654,P=0.001);PI与Ⅳ期股骨头骺高度患侧与健侧比值呈显著正相关性(r=0.636,P=0.001)。ROC分析表明:PI对病变是否可以跳过Ⅱb期的截断值为38.9%,敏感度88.9%,特异度为50%,曲线下面积为0.778(95%CI:0.597~0.959,P=0.021)。[结论]增强核磁灌注指数对早期Perthes病的修复时间与股骨头高度变化有一定的预测作用。Perthes病早期股骨头骺灌注良好,坏死的股骨头可以更快进入Ⅲa期,病程更有可能跳过Ⅱb期,愈合后股骨头骺高度更接近正常。
[Objective]To explore the significance of enhanced MRI perfusion index(PI)in evaluating the long-term prognosis of early-stage Legg-Calve-Perthes(LCP)disease.[Methods]A retrospective study was conducted on 26 children who had early-stage LCP disease diagnosed and treated in our hospital from October 2016 to December 2019.All the children had the lesion involved unilaterally,with 2 cas⁃es in modified Waldenström stageⅠa,15 in stageⅠb,and 9 in stageⅡa by X ray at initial diagnosis.All the children underwent imaging checks,including enhanced MRI,to measure PI and other imaging parameters.After 6 to 8 weeks of abduction and internal rotation plaster fixation of both lower limbs,they were further fixed to stageⅢa with abduction and internal rotation support.As the repair of the lateral 1/3 of the femoral head achieved,the children abandoned crutches and avoid sports until stageⅣ.[Results]Among the 26 children,6(23.1%)had PI<25%,while the remaining 20(76.9%)with PI≥25%at at the initial diagnosis.In term of univariate comparison,there were no signifi⁃cant differences in age,gender,lesion side and Waldenström stage at the initial diagnosis between the two groups(P>0.05).In addition,there was no significant difference in the metaphysis width ratio of affected side to healthy side and articulo-trochanteric distance(ATD)ratio side to side as entering stageⅣbetween the two groups(P>0.05).However,the PI<25%group had a significantly smaller PI than the PI≥25%group[%,(14.4±4.2)vs(50.3±21.4),P<0.001],the PI<25%group consumed significantly longer time to enter the stageⅢa than the PI≥25%group[years,(1.3±0.2)vs(0.8±0.3),P<0.001],the PI<25%group had significantly lower epiphyseal height ratio of the affected side to the healthy side than the PI≥25%group as entering stageⅣ[%,(58.6±17.0)vs(79.7±12.6),P=0.001],and the PI<25%group had signifi⁃cantly lower chance of skipping stageⅡb than the PI≥25%group(0 vs 40.0%,P=0.017).In term of pairwise correlation analysis,the PI was significantly negatively correlated with the time interval to enter stageⅢa(r=-0.654,P=0.001),whereas the PI was significantly positively correlated the epiphyseal height ratio of the affected side to the healthy side as entering stageⅣ(r=0.636,P=0.001).In term of ROC analy⁃sis,the PI predicting whether lesions could skip stageⅡb was with cutoff of 38.9%,sensitivity of 88.9%,specificity of 50%,and area under the curve of 0.778(95%CI:0.597~0.959,P=0.021).[Conclusion]The enhanced MRI perfusion index might predict the repair time and the height change of femoral head in early-stage LCP disease.The better blood perfusion in the early stage of LCP disease,the faster enteringⅢa stag,the more likely to skip theⅡb stage,and closer to normal in the femoral head epiphysis height after healing of the femoral head necrot⁃ic lesion.
作者
张华东
杨建平
付喆
廖世杰
曹毅
张中礼
ZHANG Hua-dong;YANG Jian-ping;FU Zhe;LIAO Shi-jie;CAO Yi;ZHANG Zhong-li(Department of Pediatric Orthopedics,Tianjin Hospital,Tianjin University,Tianjin 300000,China;Department of Traumatic Orthopedics and Hand Surgery,The First Affil-iated Hospital of Guangxi Medical University,Nanning 530021,Guangxi,China)
出处
《中国矫形外科杂志》
北大核心
2026年第4期299-304,共6页
Orthopedic Journal of China
基金
广西自然基金面上项目(编号:2022JJAA141098)。
