The Analysis Of Bone Marrow Edema And Collapse In Osteonecrosis Of The Femoral Head On Clinical And Bone Histomorphometric

This study was divided into two parts,the first part take the clinical case as the object of study,analysising the clinical correlation between bone marrow edema of ONFH and collapse.The second part take the bone tissue specimens of the ONFH as the object of study,analysising the bone morphometric changes in the different parts of the femoral head bone tissue.Part 1 Clinical analysis on bone marrow edema and collapse in the osteonecrosis of the femoral headObjectiveThe correlation between the age,BMI,etiology,VAS score,ARCO staging,JIC classification,Harris score,TCM syndromes and the bone marrow edema were analysised by a static way,to explore the relationship between bone marrow edema and collapse.Dynamic observation of the relationship between bone marrow edema and collapse occurred,clearing the correlation between bone marrow edema and collapse.Investigating the relationship between bone marrow edema and X-ray changes after collapse and postoperative hip preservation to explore the significance of bone marrow edema in the collapse of ONFH and the hip preservation.Methods(1)The BME in the 70 cases(120 hips)with ONFH were analyzed by age(<30 years,30?40 years,40?50 years,50?60 years),BMI(lean constitution,no rmal constitution,overweight constitution),VAS score(no pain,mild pain,m oderate pain),ARCO staging(?,?,?,?),JIC classification(A,B,C1,C2),BM E rating(0,1,2,3),Harris score(excellent,good,ok and poor),TCM syndromes(qi stagnation and blood stasis type,kidney deficiency and blood stasis t ype,phlegm stagnation type).The nonparametric tests were performed on age,BMI,etiology,VAS score,ARCO staging,JIC classification,Harris score,TCM s yndromes and BME grade.The ?2 test were taken between the factors and the occurrence of BME,analysising the clinical correlation between the each f actor and BME classification and occurrence,and exploring the relationshi p between the BME and collapse.(2)The 52 cases(71 hips)with not collapsed cases of ONFH,34 males wit h 48 hips and 18 females with 23 hips,according to BME rating(0,1,2,3),di fferent TCM syndromes(qi stagnation and blood stasis type,kidney deficien cy and blood stasis type,phlegm stagnation type),different JIC classifica tion(A,B,C1,C2)were grouped.Taking the collapse as a clinical end point e vent,Kaplan-Meier survival analysis of the collapsed cases was performed to compare the differences between different BME grades,different TCM syn dromes,different JIC classification and their survival differences.(3)The 60 cases(81 hips)with collapsed of the ONFH,43 males with 61 hips and 17 females with 20 hips,were followed up and grouped according to the improved BME grade(no BME,mild BME,severe BME).Every 3 months review the double hip joint frog bit X-ray film,to observe the influence of BME classification on the X-ray changes after the collapse of ONFH,and to observe the X-ray changes of the prognosis of the frog bit collapse,the joint match and the joint stability.(4)The 17 cases(24 hips)were retrospectively analyzed.There were 11 males cases with 17 hips,6 females cases with 7 hips.The patients were divided into two groups,no BME(grade 0)6 hips,BME 18 hips(5 hips of grade 1,7 hips of grade 2,6 hips of grade 3).The mean time of postoperative MRI was 9.50±3.30 months.The patients were followed up by X-ray and the patients were treated with THA as the clinical end points.6 hips taked a operation of THA during the follow-up and taked the Kaplan-Meier survival analysis.At the same time,the X-ray changes of 18 hips(without THA)were observed and the effect of BME on X-ray changes and prognosis were analyzed.Results(1)70 cases(120 hips)were included in the study,and the non-parametric test of multiple independent samples was carried out for each factor and BME grade.The ?2 test were taken between the factors and the occurrence of BME.?There was no significant difference between age and BME grade(?2=0.273,P=0.965).There was no significant difference between age distribution and BME(?2=0.487,P=0.922).There was no significant difference between BMI and BME grade(?2=0.507,P=0.776).There was no significant difference between BMI and BME(?2=0.231,P=0.891).?There was no significant difference between the etiology and BME grade(?2?1.763,P=0.414).There was no significant difference between the etiology and the occurrence of BME(?2=3.088,P=0.378).?VAS score and BME grade were statistically different(?2=27.449,P=O.000),VAS score was statistically different from the occurrence of BME(?2=28.452,,P=0.000).?There were significant differences in the scores of ARCO and BME(?2=16.338,P=0.000).There was a statistically significant difference between the ARCO staging and the occurrence of BME(?2=20.990,P=0.000).?There was a significant difference between JIC classification and BME grade(?2=19.486,P=0.000).There was a statistically significant difference between the JIC classification and the occurrence of BME(?2=12.312,P=0.006).?There was a significant difference between the Harris score and the BME score(?2=-4.022,P=0.000).There was a statistically significant difference between the Harris score and the occurrence of BME(?2=5.273,P=0.031).?There was no significant difference between TCM syndromes and BME grade(?2=0.410,P=0.815).There was no significant difference between the TCM syndromes and the occurrence of BME(?2=0.410,P=0.815).?There was a significant difference between the collapse and BME grade(Z=-4.022,P=0.000).There was a significant difference between the collapse and the occurrence of BME(x 2 test of paired count data,P=0.000).(2)52 cases(71 hips)were followed up for 3 to 28 months.The mean follow-up was 17.76±4.47 months.32 cases had collapsed,the survival time was 3 to 28 months,the average survival time was 9.78±6.51 months.The relationship between BME classification,different TCM syndromes,different JIC classification and collapse occurred and their survival analysis were as follows:?There were significant differences in different BME grades and collapses(?2=18.523,0.00),different BME grades and collapses(?z=14.743,P=0.002).There was significant difference between grade 0 and grade 1,grade 2 and grade 3(P<0.05),and grade 1 and grade 3 were statistically significant differences(P=0.033<0.05).There was no significant difference between different TCM syndromes and collapse(?2=4.388,P=0.117).There was no significant difference in survival time between different TCM syndromes and subsidence(P>0.1).There was a significant difference between different JIC classification and subsidence(P<0.05),and the difference between JIC classification and collapse was statistically significant(P<0.05),type A and C1,C2,B and C2 were statistically different(P<0.05).(3)60 cases(81 hips)had complete follow-up data.The follow-up time was 4?72 months,the average time was 14.47±8.23 months.By the ?2 test of R*C,the different BME grades would affect the progress of X-ray after collapse(positive frog bit collapse,the joint match,joint stability),and there was statistically different(P<0.05).(4)17 cases of 24 hips after hip surgery follow-up data integrity,the mean follow-up time was 14 to 67 months.The average time was 34.42 ±15.54 months,no BME with 6 hips,and 18 hips in BME group.There was a significant difference(x 2=3.863,P=0.049<0.05)in the total hip arthroplasty(no BME 2 hips,with BME 4 hips)during the follow-up of the subsidence.There was statistical difference(P<0.05)in the X-ray of posterior frog bit collapse after BME.There was no statistical difference(P>0.05)between the presence or absence of BME on the stability and the joint match.Conclusion?There was no correlation between BME and age,BMI,etiology and TCM syndromes.BME was positively correlated with VAS score,the higher the BME grade,the more severe the pain.BME was negatively correlated with Harris score,the higher the BME grade,the lower the Harris score.BME and ARCO staging are closely related,most of the BME occurred in the pericollapse stage osteonecrosis of the femoral head(ARCO ?,ARCO ?),less occurred in ARCO? and ARCO ?.BME is positively correlated with JIC classification,the higher the BME classification,the higher the JIC classification.BME is highly correlated with collapse.?BME is highly correlated with the occurrence of subsidence,the higher the BME classification,the more prone to collapse,the closer the subsidence occurs,the shorter the survival time of the femoral head.BME is an important imaging indicator for assessing the progression of ONFH.BME indicates that the femoral head is unstable and stress concentrates,indicating that the ONFH is about to collapse or collapsed,which is a "will collapse or collapsed"state,which should to take a great importance.?BME is widely observed after the collapse of ONFH,BME will fully affect the X-ray changes after collapse,the higher the BME classification,the higher the probability of the frog bit collapse,the joint match,the joint stability of the X-ray progress.BME is an important imaging indicatorsto assess the posterior collapse of ONFH prognosis.?BME can significantly affect the X-ray of femoral head frog bit,and the prognosis is worse.BME can be used as an evaluation of the efficacy of hip surgery.Dynamic observation of BME can assess the effect of hip treatment bitterly.Part 2 Bone histomorphometric analysis of ONFHObjectiveBone histomorphometric method was used to analyze the static parameters of bone tissue in different regions of femoral head necrosis.The differences of bone morphological differences between different types of necrotic areas and different types of necrotic bone marrow edema were compared and the causes of bone morphological parameters in bone marrow edema were analyzed for its clinical significance.MethodTaking the preoperative ipsilateral femoral head with BME as cases fo r the study,5 cases about steroid-induced femoral head necrosis and 5 cas es about alcoholic femoral head necrosis.Different regions(Subchondral bo ne,necrotic bone,sclerotic zone,BME area,normal bone tissue)were observe d under HE staining and toluidine blue staining under the microscope,and the femoral head specimens were treated with HE staining and toluidine bl ue staining.40 times under the microscope to take pictures,each specimen in the necrotic bone area,sclerotic zone,BME area,normal bone tissue are a taking 3 to 5 field of vision,the use of medical professional image ana lysis software IPP(Image pro plus6.0)on the tissue area(T.Ar),trabecular bone area(Tb.Ar),trabecular perimeter(Tb.Pm),percent trabecular area(BV/TV),trabecular thickness(Tb.Th),trabecular number(Tb.N),trabecular separa tion(Tb.Sp).Statistical analysis of bone morphometric differences between different types of necrotic necrosis and different types of necrotic BM E.ResultCompared with normal bone tissue,the trabecular bone(Tb.Ar)?trabecular circumference(Tb.Pm)?trabecular bone relative volume(BV/TV)and trabecular bone thickness(Tb.Th)in the area of necrotic bone were significantly decreased(P<0.05);the relative volume of the trabecular bone(BV/TV)?trabecular bone thickness(Tb.Pm)and trabecular bone thickness(Tb.Th)were significantly increased in the sclerotic zone(P<0.05),and trabecular bone separation(Tb.Sp)decreased;the trabecular bone thickness(Tb.Th)?trabecular bone thickness(Tb.Pm)?trabecular bone separation(Tb.Sp)?trabecular bone(Tb.Ar)?the number of trabecular bone(Tb.N)and the relative volume of trabecular bone(BV/TV)were significantly decreased(P<0.05).In the different types of femoral head necrosis about BME region bone tissue comparison,the tissue area(T.Ar)?trabecular bone(Tb.Ar).the relative volume of trabecular bone(BV/TV)and the number of trabecular bone(Tb.N)were significantly lower than those of alcoholic femoral head necrosis(P<0.05).Conclusion? BME region of trabecular bone sparse,bone loss,relative to osteoporosis,the steroid-induced femoral head necrosisis more obviously,this change is due to the stress block of the sclerotic zone and the local high metabolic state.?BME is the instability of the femoral head to activate the RAP to m ake the trabeculae active reconstruction activities in the imaging perfor mance.The presence of BME indicates that there is a more severe stress co ncentration above it,and there is mechanical instability around the BME.?The persistence of BME and the expansion of the image is an increase in the instability of the head,indicating the ONFH is about to collapse or has collapsed,is a "will collapse or collapsed" state.