目的:本研究旨在评估股骨颈轴角(FNSA)的测量是否有助于区分股骨头应力性骨折(SF)和血管坏死(AVN)。
方法:从2019年9月到2022年4月,64名患者[中位年龄32.0岁,我们的回顾性研究包括同时接受髋部X线片和磁共振成像(MRI)并诊断为股骨头SF或AVN的四分位间距(IQR)23.0-39.0年].患者分为股骨头SF(n=34)或AVN(n=30)。FNSA是在前后髋关节X线摄影中测量的。使用Mann-WhitneyU检验比较连续值。通过受试者操作特征(ROC)分析评估FNSA对股骨头SF的预测价值。
结果:SF患者的FNSA明显更高(中位数133.5°,IQR128.0-136.7°)比AVN(中位数127.5°,IQR124.0-132.0°)(p=0.001)。此外,FNSA在SF股骨中明显更高(中位数134.8°,IQR129.2-137.4°)比对侧正常股骨(中位数127.1°,单侧股骨头SF患者的IQR124.3-132.5°)(n=30)(p<0.001)。在ROC分析中,灵敏度,特异性,预测股骨头SF的曲线下面积(AUC)为77.3%,63.3%,和0.785(95%置信区间:0.666-0.905),分别,在130.2°的截止处。
结论:FNSA增加与股骨头SF相关;因此,FNSA的测量有助于鉴别股骨头SF和AVN。
The study aimed to evaluate whether the measurement of Femoral Neck Shaft Angle (FNSA) can be helpful in differentiating femoral head Stress Fracture (SF) from Avascular Necrosis (AVN).
From September 2019 to April 2022, sixty-four patients [median age 32.0 years, interquartile range (IQR) 23.0-39.0 years] who underwent both hip radiograph and Magnetic Resonance Imaging (MRI) and diagnosed as femoral head SF or AVN were included in our retrospective study. Patients were divided into as having either femoral head SF (n = 34) or AVN (n = 30). The FNSA was measured in anteroposterior hip radiography. Continuous values were compared using the Mann-Whitney U test. The assessment of the predictive value of FNSA for femoral head SF was performed by Receiver Operating Characteristic (ROC) analysis.
The FNSA was significantly higher in patients with SF (median 133.5°, IQR 128.0-136.7°) than those with AVN (median 127.5°, IQR 124.0-132.0°) (p = 0.001). In addition, the FNSA was significantly higher in SF femurs (median 134.8°, IQR 129.2-137.4°) than in contralateral normal femurs (median 127.1°, IQR 124.3-132.5°) in patients with unilateral femoral head SF (n = 30) (p < 0.001). In ROC analysis, the sensitivity, specificity, and Area Under the Curve (AUC) for predicting the femoral head SF were 77.3%, 63.3%, and 0.785 (95% confidence interval: 0.666-0.905), respectively, at a cutoff of 130.2°.
Increased FNSA was associated with femoral head SF; thus, measurement of FNSA could be helpful for differentiating femoral head SF from AVN.