Rieger B, Friederich N F, Rasch H, Hirschmann M T
Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparates, Kantonsspital Baselland-Bruderholz, CH-4101, Bruderholz, Schweiz,
Unfallchirurg. 2014 Apr;117(4):369-73. doi: 10.1007/s00113-013-2421-2.
Osteoporotic fragility fractures of the femoral neck are the most common type of fractures in the elderly and are associated with a high mortality. Most frequently these fractures are due to falls but spontaneous onset has also been described. In these patients the insufficient quantity and quality of the osteoporotic bone finally leads to the development of a fragility or insufficiency fracture. In some cases of nondisplaced insufficiency fractures the diagnosis cannot be established by conventional radiographs alone and magnetic resonance imaging (MRI), single proton emission computed tomography (SPECT) or SPECT/CT are considered as diagnostic adjuncts. We report the case of an 83-year-old patient who had complained of ongoing weight-bearing pelvic pain for over 6 months. There was no history of trauma. The clinical conventional radiographs as well as CT could not elucidate the cause of the problems. To differentiate between lumbal and hip pain a SPECT/CT was performed and the diagnosis of a medial femoral neck insufficiency fracture was established. In the delayed phase a band-like increased tracer uptake within the medial femoral neck was observed. The SPECT/CT procedure is a promising diagnostic alternative for geriatric patients and can be particularly recommended in cases of persistent unclear pelvic or lumbar spine pain in the elderly.
股骨颈骨质疏松性脆性骨折是老年人最常见的骨折类型，且与高死亡率相关。这些骨折最常见的原因是跌倒，但也有自发发生的报道。在这些患者中，骨质疏松性骨的数量和质量不足最终导致脆性或不全骨折的发生。在一些无移位的不全骨折病例中，仅通过传统X线片无法确诊，磁共振成像（MRI）、单光子发射计算机断层扫描（SPECT）或SPECT/CT被视为诊断辅助手段。我们报告一例83岁患者，其诉说负重时骨盆疼痛持续6个月以上。无外伤史。临床常规X线片及CT均无法明确问题原因。为鉴别腰痛和髋部疼痛，进行了SPECT/CT检查，确诊为股骨颈内侧不全骨折。在延迟期，观察到股骨颈内侧有条带状放射性示踪剂摄取增加。SPECT/CT检查对老年患者是一种有前景的诊断选择，尤其对于老年人持续存在的不明原因骨盆或腰椎疼痛的情况可特别推荐。
