目的 探讨CT联合骨密度测量在 诊断股骨头无菌性坏死中的价值。方法 选取2015年3月至2016年5月我院收治的股 骨头无菌性坏死患者46例为研究对象， 术前均行CT检查及骨密度测量，分析CT 表现特征：Ⅰ期改变不明显或有点滴密 度改变，见星芒征，Ⅱ期现囊状透亮及斑 片骨硬化区，囊性骨质吸收，Ⅲ期股骨头 内骨小梁明显变形消失，股骨头前上部 关节面下见窄细状透亮宽带，即“新月 征”，Ⅳ期股骨头变形并有间隙变化， 周围有硬化或不规则；记录骨密度测量 骨密度值与骨矿含量，评价CT联合骨密 度测量、单纯CT诊断股骨头无菌性坏死 的灵敏度、特异度、准确度。结果 CT检 查：Ⅰ期6例；Ⅱ期19例；Ⅲ期15例；Ⅳ 期6例；骨密度测量结果：男性股骨颈及 全髋关节感兴趣区骨密度、骨矿含量高于 女性(P均＜0.05)；一致性检验Kappa值为 0.743，P<0.05。CT联合骨密度测量的诊 断股骨头无菌性坏死的灵敏度80.00％、 准确度78.26％明显高于单纯CT检查(P均 ＜0.05)；CT联合骨密度测量诊断股骨头 无菌性坏死的ROC曲线下面积0.947明显高 于单纯CT检查，差异有统计学意义(P＜ 0.05)。结论 CT联合骨密度测量在股骨头 无菌性坏死诊断中具有较高应用价值，值 得在临床推广应用。

Objective To investigate the value of CT and determination of bone mineral density in the diagnosis of aseptic necrosis of femoral head. Methods Forty-six cases with aseptic necrosis of the femoral head treated in our hospital between March 2015 and May 2016 were selected as the study subjects. All cases underwent CT examination and bone mineral density detection before operation. The CT findings included not obvious change or a bit change of density, star sign in stage I , cystic bright and patchy bone sclerosis and cystic bone resorption in stage II, obvious deformation or disappearance of trabeculae in femoral head, narrow and thin broad band under the articular surface of upper and anterior femoral head, namely, the crescent sign in stage III, femoral head deformation and changes of spaces, around or irregular sclerosis in stage IV. The bone mineral density and bone mineral content were recorded. The sensitivity, specificity and accuracy of CT and determination of bone mineral density and single CT scan in the diagnosis of aseptic necrosis of femoral head were compared and evaluated. Results The results of CT examination showed that there were 6 cases in stage I, 19 cases in stage II, 15 cases in stage III anf 6 cases in stage IV. The results of bone mineral density determination showed that bone mineral density and bone mineral content in the region of interest of femoral neck and hip in male patients were higher than those in female patients (P<0.05). The Kappa value of consistency test was 0.743 (P<0.05). The diagnostic sensitivity and accuracy of CT combined with determination of bone mineral density (80.00%, 78.26%) were significantly higher than those of simple CT examination (P<0.05) in the diagnosis of aseptic necrosis of femoral head. The area under ROC of CT and bone mineral density detection in the diagnosis of femoral aseptic necrosis (0.947) was significantly larger than that of simple CT examination (P<0.05). Conclusion Conbined CT and determination of bone mineral density is of high value in the diagnosis of aseptic necrosis of the femoral head.