Parikh Ashishkumar K, Washington Eleby R, Bobbey Adam J, Spottswood Stephanie E
Department of Radiology, Nemours Children's Health System, 807 Children's Way, Jacksonville, FL, 32207, USA.
Department of Radiology, Vanderbilt University Medical Center, Vanderbilt Children's Hospital, Nashville, TN, USA.
Pediatr Radiol. 2018 Mar;48(3):350-358. doi: 10.1007/s00247-017-4030-7. Epub 2017 Nov 27.
Evaluating postoperative patients with hardware is challenging following surgical intervention for hip maladies such as femoral neck fractures and slipped capital femoral epiphysis (SCFE). These children are at increased risk of developing avascular necrosis, and imaging may be requested to confirm or exclude this diagnosis. Children with Legg-Calvé-Perthes disease can be monitored for restoration of blood flow to the capital femoral epiphysis to guide management and help with prognosis. Although MRI is sensitive for detecting early avascular necrosis, the presence of hardware degrades image quality.
This report examines the utility of bone scans for evaluating femoral head perfusion in children who have undergone surgery for femoral neck fractures, SCFE or Legg-Calvé-Perthes disease.
A retrospective review of 20 patients (22 scans) after fixation for femoral neck fracture, SCFE or Legg-Calvé-Perthes disease from 2012 to 2015 was performed. The bone scan findings were correlated with the intraoperative findings or clinical follow-up.
Twenty-one of the 22 (95%) bone scans in 19 of the 20 (95%) patients demonstrated findings consistent with clinical outcomes and/or the intraoperative appearance of the femoral head. Four of 20 patients (20%) had bone scan features of avascular necrosis, defined as "absent" or "moderately diminished" femoral head activity, which were confirmed intraoperatively and resulted in poor outcomes.
Radionuclide imaging of hips in the postoperative setting is a valuable modality for assessing the risk of avascular necrosis, a complication of femoral neck fractures and SCFE and for evaluating the restoration of flow to the capital femoral epiphyses of children with Legg-Calvé-Perthes disease.
对于因股骨颈骨折和股骨头骨骺滑脱（SCFE）等髋部疾病接受手术干预后的患者，评估其体内植入物情况具有挑战性。这些儿童发生缺血性坏死的风险增加，可能需要进行影像学检查以确诊或排除该诊断。患有Legg-Calvé-Perthes病的儿童可通过监测股骨头骨骺血流恢复情况来指导治疗并辅助判断预后。尽管MRI对检测早期缺血性坏死很敏感，但植入物的存在会降低图像质量。
本报告探讨骨扫描在评估因股骨颈骨折、SCFE或Legg-Calvé-Perthes病接受手术的儿童股骨头灌注情况中的应用价值。
对2012年至2015年因股骨颈骨折、SCFE或Legg-Calvé-Perthes病行内固定术后的20例患者（22次扫描）进行回顾性研究。骨扫描结果与术中所见或临床随访情况进行对比。
20例患者中的19例（95%）的22次骨扫描中有21次（95%）显示的结果与临床结局和/或股骨头术中表现一致。20例患者中有4例（20%）骨扫描显示有缺血性坏死特征，即股骨头活性“缺失”或“中度降低”，术中得到证实且预后不佳。
术后对髋部进行放射性核素成像，是评估缺血性坏死风险（股骨颈骨折和SCFE的一种并发症）以及评估Legg-Calvé-Perthes病患儿股骨头骨骺血流恢复情况的一种有价值的方法。
