Mri of early osteonecrosis of the femoral head after transcervical fracture
Mri of early osteonecrosis of the femoral head after transcervical fracture
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DOI：
10.1302/0301-620x.78b2.0780253
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发表时间：
1996-03-01
影响因子：
--
通讯作者：
Hayami, Y
中科院分区：
文献类型：
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作者：
Sugano, N;Masuhara, K;Hayami, Y
我们对17例(女性14例，男性3例)股骨颈骨折患者进行了前瞻性研究，平均年龄48岁(21~76岁)，其中2例为Garden I期骨折，12例为II期骨折，3例为m期骨折。我们在放射学控制下，于伤后5天(2~15天)用钛空心松质骨螺钉或钛加压髋部螺钉进行内固定，分别于术后1、6、12个月行MRI检查，然后每年用自旋回波技术获得T1和T2加权像。术后1个月17个髋关节中有8个髋关节在T1加权像上呈低信号带，在T2加权像上呈高信号带，显示股骨头内病变远离骨折线。这些病变分为三种类型：I型为股骨头上外侧区的小梗死灶，3个髋关节可见；II型为股骨头上外侧区至中心凹的浅层病变(3个髋关节)；III型为股骨头大部分的大病灶(2个髋关节)。术后6个月MRI检查未见进一步改变，3个I型病变未见股骨头塌陷，但3个II型病变中2个髋关节及两个III型髋关节随后塌陷，最终随访时3个I型病变髋关节和1个II型髋关节仍无症状，但X线片显示与MRI病变对应的股骨头硬化。术后1个月MRI检查未见异常的9个髋关节，末次随访时体格检查、X线片及MRI均无异常发现。
We have carried out a prospective study of 17 patients (14 women, 3 men) of mean age 48 years (21 to 76) with transcervical fractures of the femur using MRI to detect early evidence of avascular necrosis of the head.Two fractures were Garden stage I, 12 stage II, and three stage m. We performed internal fixation under radiological control at a mean of five days (2 to 15) after injury using a titanium cannulated cancellous screw or a titanium compression hip screw, MRI was performed at one, six and 12 months and then yearly after operation, T1- and T2-weighted images were obtained by a spin-echo technique. The duration of follow-up of patients who did not subsequently require replacement of the head of the femur was from 2 to 5 years (mean 3.2).One month after operation eight of the 17 hips showed a band of low signal intensity on T1-weighted images and high signal intensity on T2-weighted images indicating lesions in the femoral head away from the fracture line. These were of three types: type I was a small infarct at the superolateral region of the femoral head and was seen in three hips; type II was a shallow lesion from the superolateral region to the fovea of the femoral head (three hips); and type III was a large lesion occupying most of the femoral head (two hips). No further changes were seen in the MRI after six months from operation, Collapse of the femoral head did not occur in the three hips with type-I lesions, but two of the three type-II hips and both type-III hips subsequently collapsed, At the final follow-up the three hips with a type-I lesion and one with a type-II were still asymptomatic but radiography showed sclerosis in the femoral head corresponding to the MRI lesions. The nine hips which showed no changes on MRI at one month had no abnormal findings on physical examination, radiography or MRI at final follow-up.