1 Department of Diagnostic Radiology, Martin Army Community Hospital, 6600 Van Aalst Blvd, Fort Benning, GA 31905-5637.
2 Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.
AJR Am J Roentgenol. 2018 Mar;210(3):601-607. doi: 10.2214/AJR.17.18639. Epub 2018 Jan 16.
The objective of this study is to formulate a new MRI classification system for fatigue-type femoral neck stress injuries (FNSIs) that is based on patient management and return-to-duty (RTD) time.
A retrospective review of 156 consecutive FNSIs in 127 U.S. Army soldiers over a 24-month period was performed. The width of marrow edema for low-grade FNSIs and the measurement of macroscopic fracture as a percentage of femoral neck width for high-grade FNSIs were recorded. RTD time was available for 90 soldiers. Nonparametric testing, univariate linear regression, and survival analysis on RTD time were used in conjunction with patient management criteria to develop a new FNSI MRI classification system.
The FNSI incidence was 0.09%, and all FNSIs were compressive-sided injuries. RTD time was significantly longer for high-grade FNSIs versus low-grade FNSIs (p < 0.001). Our FNSI MRI classification system showed a significant difference in RTD time between grades 1 and 2 (p = 0.001-0.029), 1 and 3 (p < 0.001), and 1 and 4 (p = 0.001-0.01). There was no significant RTD time difference between the remaining grades. The rates of completing basic training (BT) and requiring medical discharge were significantly associated with the FNSI MRI grades (p = 0.038 and p = 0.001, respectively).
The proposed FNSI MRI classification system provides a robust framework for patient management optimization by permitting differentiation between operative and nonoperative candidates, by allowing accurate prediction of RTD time, and by estimating the risk of not completing BT and requiring medical discharge from the military.
本研究旨在制定一种新的基于患者管理和重返工作岗位（RTD）时间的股骨颈疲劳性应力性损伤（FNSI）MRI 分类系统。
回顾性分析了 24 个月内 127 名美国陆军士兵的 156 例连续 FNSI，记录了低级别 FNSI 的骨髓水肿宽度和高级别 FNSI 的宏观骨折测量值占股骨颈宽度的百分比。90 名士兵的 RTD 时间可用。使用非参数检验、单变量线性回归和 RTD 时间生存分析，结合患者管理标准，制定了一种新的 FNSI MRI 分类系统。
FNSI 的发病率为 0.09%，所有 FNSI 均为压缩侧损伤。高级别 FNSI 的 RTD 时间明显长于低级别 FNSI（p < 0.001）。我们的 FNSI MRI 分类系统显示 RTD 时间在 1 级和 2 级（p = 0.001-0.029）、1 级和 3 级（p < 0.001）以及 1 级和 4 级（p = 0.001-0.01）之间有显著差异。其余级别之间的 RTD 时间无显著差异。完成基础训练（BT）和需要医疗退役的比例与 FNSI MRI 分级显著相关（p = 0.038 和 p = 0.001）。
提出的 FNSI MRI 分类系统通过允许区分手术和非手术候选者、准确预测 RTD 时间以及估计未能完成 BT 和需要从军队退役的风险，为患者管理优化提供了一个强大的框架。
