联合X线及MRI特征对早期非创伤性股骨头坏死塌陷的预测价值

doi:10.3969/j.issn.1006-5725.2026.05.012

Abstract

Abstract:

Objective To explore the value of constructing a nomogram based on the combined X-ray and MRI imaging characteristics for predicting the risk of early non-traumatic osteonecrosis of the femoral head （NONFH） collapse. Methods Clinical， X-ray， and MRI data from 149 early-stage NONFH patients （237 hips） at two medical centers were collected and then divided into training and validation cohorts. Univariate and multivariate Cox regression analyses were carried out to pinpoint independent predictors of femoral head collapse. Single-factor and multi-factor predictive models for 3-year and 5-year outcomes were developed. The performance of the models was evaluated using the area under the curve （AUC）， and the consistency of the models was assessed using the concordance index （C-index）. The optimal model was chosen for nomogram construction. Internal validation was carried out with the training cohort， and external validation was performed using the validation cohort. Results A total of 159 hips from center 1 and 78 hips from center 2 were incorporated into the study. Multivariate Cox regression analysis pinpointed the JIC classification （HR = 37.78， 95%CI： 4.631 - 308.15， P < 0.001）， joint effusion （HR = 1.613， 95%CI： 1.037 - 2.509， P = 0.034）， and necrosis index （HR = 1.016， 95%CI： 1.003 - 1.028， P = 0.012） as independent predictors of femoral head collapse. Both internal and external validations verified that the combined model for 3-year and 5-year prediction displayed superior performance， enhanced accuracy， and increased net benefit. Calibration curves revealed a good concordance between the risk probabilities predicted by the nomogram and the actual observed outcomes. Conclusion The nomogram constructed on the basis of X-ray and MRI imaging features can effectively predict the risk of femoral head collapse in patients with NONFH， offering crucial guidance for the formulation of individualized clinical intervention strategies.

Key words: early non-traumatic osteonecrosis of the femoral head, femoral head collapse, Cox regression, nomogram

CLC Number:

R445

Maoting TANG,Zhen WANG,Xiaoxia PING,Nan JIANG,Qian MENG. The predictive value of combined X-ray and MRI features for early non-traumatic osteonecrosis of the femoral head collapse[J]. The Journal of Practical Medicine, 2026, 42(5): 814-823.

Figures/Tables 10

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References 25

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变量	未塌陷（n = 76）	塌陷（n = 83）	χ²/Z值	P值
年龄/岁	38.5（31.0，44.0）	40.0（34.0，46.0）	-1.139	0.255
髋关节评分/分	16.0（15.0，18.0）	15.0（14.0，16.0）	-3.331	0.001
BMI/（kg/m²）	23.4（22.5，24.5）	23.5（21.9，25.0）	-0.500	0.617
性别/例			0.878	0.349
女	33	30
男	43	53
患侧/例			1.743	0.187
右	36	48
左	40	35
病因/例			7.607	0.022
激素	47	50
酒精	12	25
特发	17	8
坏死指数/%	25.4（16.9，36.2）	68.7（57.3，85.4）	-9.878	< 0.001
Ficat分期/例			27.114	< 0.001
Ⅰ期	38	10
Ⅱ期	38	73
JIC分型/例			104.237	< 0.001
A + B型	61	1
C型	15	82
Goutallier分级/例			16.761	0.001
1级	11	4
2级	62	58
3级	3	19
4级	0	2
关节积液/例			40.534	< 0.001
轻度	39	10
中度	24	21
重度	13	52
坏死区囊变/例			2.047	0.153
无	59	56
有	17	27
骨髓水肿/例			35.880	< 0.001
0级	20	3
1级	36	23
2级	12	20
3级	8	37

变量	训练集（n = 159）	验证集（n = 78）	χ²/Z值	P值
随访时间/月	36.0（26.0，61.0）	36.5（24.0，48.0）	-1.375	0.169
年龄/岁	40.0（32.0，45.0）	36.0（29.0，45.0）	-1.218	0.223
髋关节评分/分	15.0（14.0，17.0）	15.5（14.0，17.0）	-0.538	0.590
BMI/（kg/m²）	23.4（22.1，24.8）	23.4（21.6，25.2）	-0.425	0.671
结局/例			0.018	0.894
未塌陷	76	38
塌陷	83	40
性别/例			0.341	0.559
女	63	34
男	96	44
患侧/例			0.168	0.682
右	84	39
左	75	39
病因/例			3.206	0.201
激素	97	56
酒精	37	11
特发	25	11
坏死指数/%	50.8（26.5，72.7）	42.3（23.8，83.3）	-0.264	0.814
Ficat分期/例			0.474	0.491
Ⅰ期	48	27
Ⅱ期	111	51
JIC分型/例			0.718	0.397
A + B型	62	26
C型	97	52
Goutallier分级/例			5.205	0.157
1级	15	13
2级	120	48
3级	22	16
4级	2	1
关节积液/例			4.048	0.132
轻度	49	18
中度	45	32
重度	65	28
坏死区囊变/例			1.202	0.273
无	115	51
有	44	27
骨髓水肿/例			1.356	0.716
0级	23	11
1级	59	24
2级	32	20
3级	45	23

变量	单因素			多因素
变量	HR	95% CI	P值	HR	95% CI	P值
年龄	1.013	0.993 ~ 1.033	0.209
性别	1.249	0.798 ~ 1.956	0.331
患侧	0.756	0.489 ~ 1.169	0.208
病因	0.883	0.661 ~ 1.180	0.402
髋关节评分	0.813	0.727 ~ 0.910	< 0.001	1.02	0.890 ~ 1.168	0.777
BMI	0.985	0.879 ~ 1.105	0.8
Ficat分期	4.682	2.407 ~ 9.109	< 0.001	0.655	0.260 ~ 1.645	0.368
JIC分型	94.9	13.199 ~ 683.532	< 0.001	37.78	4.631 ~ 308.150	< 0.001
Goutallier分级	2.456	1.635 ~ 3.690	< 0.001	1.244	0.795 ~ 1.947	0.339
关节积液	2.606	1.908 ~ 3.559	< 0.001	1.613	1.037 ~ 2.509	0.034
坏死区囊变	1.299	0.820 ~ 2.056	0.265
骨髓水肿	1.944	1.555 ~ 2.431	< 0.001	1.173	0.893 ~ 1.541	0.251
坏死指数	1.039	1.030 ~ 1.048	< 0.001	1.016	1.003 ~ 1.028	0.012

模型	3年AUC（95%CI）	5年AUC（95%CI）	C指数（95%CI）	Z值	P值
JIC分型	0.783（0.658 ~ 0.839）	0.913（0.811 ~ 0.968）	0.748（0.706 ~ 0.787）	-3.630	< 0.001
关节积液	0.720（0.641 ~ 0.799）	0.765（0.677 ~ 0.853）	0.682（0.624 ~ 0.730）	-5.607	< 0.001
坏死指数	0.861（0.800 ~ 0.923）	0.876（0.801 ~ 0.951）	0.803（0.751 ~ 0.846）	-2.418	0.016
联合	0.882（0.829 ~ 0.935）	0.918（0.863 ~ 0.972）	0.818（0.773 ~ 0.856）	Ref	Ref

The predictive value of combined X-ray and MRI features for early non-traumatic osteonecrosis of the femoral head collapse

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