Adult Avascular Necrosis Of The Femoral Head Comprehensive Staging Studies

Objective Comparative analysis adult nontraumatic avascular necrosis of the femoral head (ANFH) radiological staging and different stages of imaging (MRI, CT and X-ray) and corresponding relation, evaluation of various imaging techniques in the diagnosis of early avascular necrosis of femoral, dispersion of application of weighted magnetic resonance imaging in the early diagnosis of bone necrosis of femoral. Analysis may cause bone necrosis, and discusses the different causes of nontraumatic osteonecrosis of the femoral head of the imaging and pathological manifestations are similar.Methods1、From April to2012in our hospital in2008May25cases of37hips with avascular necrosis of the femoral head were follow-up or pathological, by two senior radiologists X tablets, in all cases, the CT and MRI findings were analyzed in double blind method and stage control, comparison of different stages of X-film, imaging findings of CT and MRI. On9hips underwent diffusion-weighted magnetic resonance imaging, according to equation ADC=In (SI L/SIH)/(bH-bL) to calculate the Apparent diffusion coefficient of the femoral head (ADC), and compared with the normal group.2、25cases of venous blood of patients with osteonecrosis laboratory coagulation, fibrinolysis (activated partial thromboplastin time (APTT), antithrombin-Ⅲ (AT_Ⅲ), plasma prothrombin time (PT) compared with the normal control group.3、37hips of8hip hip replacement, the replacement of the femoral head with reference to CT, the MRI image, and according to the loading area of femoral head cartilage;②subchondral necrotic center; the repair area (including zone and the new bone granulation tissue); the normal peripheral zone, four zones were drawn, general biopsy and histopathology.Results1、37of avascular necrosis of the femoral head in0hips,0, stage I in5hips, including IA3hip,IB2hip; II10hip, IIA4、IIB3hip, IIC3hip;Ⅲ14hips, including ⅢA5、ⅢB5 hip、ⅢC4,hip, IV were8stage. X-ray diagnosis of27, wherein the early (stage Ⅰ-Ⅱ) the diagnosis rate of5/15(33.3%); CT diagnosis in32hips, the early diagnosis rate of10/15(66.6%); MRI diagnosis37, early diagnosis rate of15/15(100%); group MRI and X-ray plain film, CT data early diagnosis there was significant difference (P<0.05).2、the statistical results showed9hips (IA1cases, IIA2cases, IIB4cases, IIIA2cases) of avascular necrosis of the femoral head were treated with diffusion weighted imaging ADC=ln (SI L/SIH)/(bH-bL), calculated from the femoral head necrosis area of the ADC value was5.3±0.3×10-3mm2/s; normal femoral head corresponding regions of the ADC value was3.2±0.5×10-3mm2/s, P<0.05, there are significant differences.3、25cases of venous blood of patients with osteonecrosis laboratory coagulation, fibrinolysis (activated partial thromboplastin time (APTT), antithrombin-Ⅲ (AT_Ⅲ), plasma prothrombin time (PT) compared with the control group, decreased in varying degrees, P<0.05, significant difference between the two.4、avascular necrosis of the femoral head specimens of different etiologies have very similar performance:from the outside to the inside is divided into4layers:the cartilage, necrosis, hyperplasia reaction region, normal region of lesion of bone. Cartilage normal color or whitening, cartilage surface may be smooth or have varying degrees of wear and tear; necrotic yellow irregular wedge, occurred in the fracture under cartilage hyperplasia reaction zone; irregular Brown ribbon wrapped around the necrosis area, the area of necrosis and normal bone marrow separated.Conclusion1、Compared with other imaging methods in the early diagnosis of MRI, the sensitivity and accuracy of ANFH was higher than that of CT and X-ray plain film, STIR sequences with routine MRI examination can improve the early detection rate, has a certain significance of increased apparent diffusion head weight-bearing area coefficient DWI measured, which has potential application prospect in early diagnosis of avascular necrosis of the femoral head.2、coagulation, fibrinolysis may be the cause of low hormone and alcoholic avascular necrosis of the femoral head.3、different causes of nontraumatic osteonecrosis of the femoral head is similar to the imaging and pathological manifestations.