The Clinical Study Of Ultrasonic Characteristics And Microcirculation Perfusion Of Early Non-traumatic Osteonecrosis Of Femoral Dead

ObjectiveUsing two-dimensional ultrasound and contrast-enhanced ultrasound(CEUS)technology to observe the early non-traumatic osteonecrosis of femoral head(ARCO stageⅡ,ⅢA)and normal femoral head ultrasound characteristics,contrast agent perfusion mode,and the parameters of contrast-enhanced ultrasound were quantitatively analyzed to explore the characteristics of microcirculation perfusion of subchondral bone of femoral head in patients with early non-traumatic osteonecrosis of femoral head and to evaluate the clinical value of contrast-enhanced ultrasound in early auxiliary diagnosis of non-traumatic osteonecrosis of femoral head.Methods1.A total of 42 patients(46 hips)with early non-traumatic osteonecrosis of femoral head confirmed by MRI were collected and divided into three groups:ARCOⅡgroup with 19 patients(20 hips),ARCOⅢA group with 23 patients(26 hips)and the normal control group was also included 14 cases(14 hips).2.First,two-dimensional ultrasound examinations were performed on the femoral heads of the three groups to observe the two-dimensional ultrasound features of femoral head shape,articular surface and joint cavity effusion.3.The three groups of femoral heads were examined by contrast-enhanced ultrasound,and the characteristics of microcirculation perfusion in the subchondral bone area on the surface of the femoral heads were analyzed.The parameters of the time-intensity curve were analyzed quantitatively:Time To Peak(TTP),Enhanced Intensity(EI),Mean Transit Time(MTT),Ascending slope(AS),and Descending slope(DS).Meanwhile,the correlation between CEUS parameters and ARCO stages was analyzed to find the characteristics of microcirculation perfusion parameters in different periods of ONFH,hoping to find the ultrasonographic character of early NONFHResults1.Comparison of two-dimensional ultrasound images of femoral head between NONFH and control group:the femoral head in control group was normal in shape and smooth in articular surface,the femoral heads in stageⅡwere nearly normal in shape,the articular surface was slightly rough,and the femoral heads did not collapse.In stageⅢA,the femoral heads were flattened or collapsed to varying degrees,and the continuity of some articular surfaces was interrupted,and the joint space was narrowed.2.Comparison of quantitative parameters of femoral head contrast-enhanced ultrasound among the three groups:TTP、EI、MTT、AS and DS have significant difference(P<0.05);Compared with the control group,EI and AS in the stageⅡgroup were higher than those in the control group,while TTP,MTT and DS were lower than those in the control group(P<0.05);Compared with the control group,EI and AS in the stageⅢA group were higher than those in the control group,while TTP,MTT and DS were lower than those in the control group(P<0.05).Compared the stageⅡgroup with the stageⅢA group,EI and AS in the stageⅡgroup were lower than those in the stageⅢA group,and the difference was statistically significant(P<0.05).There was no significant difference in TTP、MTT and DS between the two groups.(P>0.05).3.Correlation analysis of three groups of femoral head ultrasound contrast quantitative parameters and staging:TTP、EI、AS、DS were all correlated with staging(P<0.05).Among them,TTP and DS were significantly negatively correlated with staging(r_s=-0.529;r_s=-0.551);EI and AS were significantly positively correlated with staging(r_s=0.594;r_s=0.658);MTT is not significantly correlated with staging(P>0.05).4.The ROC curve analysis of the quantitative parameters of contrast-enhanced ultrasound:The AUC of EI and AS were used to identify early non-traumatic osteonecrosis of femoral head were 0.825(P=0.000)and 0.901(P=0.000),respectively.Conclusion1.Two-dimensional ultrasound can differentially diagnose the contours,articular surface,and joint cavity effusions femoral head between normal people and some patients with early non-traumatic osteonecrosis of femoral head(ARCO stageⅡandⅢA).2.Contrast-enhanced ultrasound can better show the perfusion characteristics of subchondral bone microcirculation on the surface of femoral head.Compared with normal femoral head,the perfusion pattern of subchondral bone in patients with early non-traumatic osteonecrosis of femoral head necrosis is"fast in and fast out".The quantitative parameters TTP、MTT、EI、AS and DS of contrast-enhanced ultrasound can reflect the change trend of microcirculation perfusion in non-traumatic femoral head necrosis to a certain extent,especially EI and AS have certain clinical value in assisting the differential diagnosis of early non-traumatic osteonecrosis of femoral head.