目的探讨股骨头坏死(ONFH)早 期的磁共振征象与定量坏死体积测量对预 测股骨头塌陷的临床意义。方法 选取自 2012年7月至2014年7月期间于我院确诊的 股骨头坏死早期(ARCO分期Ⅰ、Ⅱ期)患 者65例(共78髋)，确诊时接受X线摄片判 定股骨头塌陷情况，并进行MRI扫描汇集 ONFH早期病情数据，包括关节腔积液量、 骨髓腔水肿、坏死形态和股骨头坏死体 积。初次检查后，患者每6个月来院接受 一次X线摄片检定股骨头是否出现塌陷。 根据随访中是否出现股骨头坏死塌陷将其 分为塌陷组和未塌陷组，比较两组研究对 象早期的各项MRI影像学指标，分析各项 指标与股骨头塌陷结局的关联性。结果 塌陷组患者股骨头总坏死体积百分比明显 高于未塌陷组，除PIM象限外的其余各象 限坏死体积百分比也明显高于未塌陷组； 关节腔积液程度甚于未塌陷组；出现骨髓 腔水肿的病例数多于未塌陷组；周围型股 骨头坏死比例高于未塌陷组，差异均有显 著性统计学意义(P<0.01)。结论 ONFH早 期的MRI征象和定量坏死体积测量对预测 股骨头坏死塌陷具有重要的临床价值。

Objective To investigate the clinical significance of prediction of collapse with early MRI signs and necrosis volume measurement for Osteonecrosis of the Femoral Head (ONFH). Methods From July 2012 to July 2014, 65 patients (78 hips) with early ONFH (ARCO Ⅰ、Ⅱ) confirmed in our hospital were included in this study. At the time of diagnosis, X-ray film was taken to determine the collapse of femoral head, and MRI scan was performed to collect early data, including the joint effusion, bone marrow edema, necrotic morphology and the volume of femoral head necrosis. After the first examination, the patients were demanded to receive an X-ray film every 6 months to observe whether the collapse of the femoral head or not. Then, all hips were divided into two groups, collapse group and non-collapse group. The early MRI signs of the two groups were compared, and the correlation between the indexes and the collapse of the femoral head was analysed. Results The total necrosis volume percentage of the femoral head of the collapse group was significantly higher than that of the non-collapse group, and the necrosis volume percentage of each quadrant were greatly higher than those of the non-collapse group except the PIM quadrant. The degree of ioint effusion of the collapse group was more than that of the non-collapse group. The cases of bone marrow edema of the collapse group was more than those of the non-collapse group. The proportion of peripheral femoral head necrosis of the collapse group was higher than that of the noncollapse group. The differences were statistically significant (P<0.01). Conclusion Early MRI signs and necrosis volume measurement have important clinical value in predicting the collapse of the femoral head.