Han Yeon-Hee, Jeong Hwan-Jeong, Sohn Myung-Hee, Yoon Sun-Jung, Lim Seok Tae
Department of Nuclear Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Cyclotron Research Center, Molecular Imaging and Therapeutic Medicine Research Center, Chonbuk National University Medical School and Hospital.
Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea.
Nucl Med Commun. 2019 Mar;40(3):199-205. doi: 10.1097/MNM.0000000000000963.
The aim of the present study was to evaluate the incidence and degree of femoral head avascularity depending on the types of femoral neck or intertrochanteric fractures using preoperative bone single photon emission computed tomography (SPECT)/computed tomography (CT).
A total of 131 patients with femoral neck or intertrochanteric fractures who underwent preoperative bone SPECT/CT were enrolled. Femoral head avascularity was evaluated using bone SPECT/CT images. Visual scores ranged from 1 to 5 based on visually assessed diagnostic confidence: 1=definitely avascular femoral head, 2=likely avascular, 3=equivocal, 4=likely not avascular, and 5=definitely not avascular. In quantitative analysis, contralateral, ipsilateral, and size ratios were measured.
Among 131 patients, 39 of 54 (72.22%) with femoral neck fractures and 23 of 77 (29.87%) with intertrochanteric fractures showed avascular femoral heads. The incidence of femoral head avascularity was significantly higher in patients with femoral neck fracture than those with intertrochanteric fracture. While the incidence and severity of femoral head avascularity increased with higher Garden stage in femoral neck fracture, neither was related to AO/Orthopaedic Trauma Association classification of intertrochanteric fracture. In addition, the number of bony fragments around intertrochanteric fractures was not a significant predictor of femoral head avascularity.
Although avascular femoral head on bone SPECT/CT does not directly indicate avascular necrosis, assessing the incidence and severity of femoral head avascularity using qualitative and quantitative parameters could give clinically useful information related to the classification. Additional studies with larger sample sizes would be a next step to expand the clinical role of bone SPECT/CT.
本研究旨在利用术前骨单光子发射计算机断层扫描（SPECT）/计算机断层扫描（CT）评估根据股骨颈或转子间骨折类型而定的股骨头缺血性发生率及程度。
共纳入131例行术前骨SPECT/CT检查的股骨颈或转子间骨折患者。利用骨SPECT/CT图像评估股骨头缺血情况。视觉评分基于视觉评估的诊断可信度从1到5分：1 = 股骨头肯定缺血，2 = 可能缺血，3 = 不明确，4 = 可能不缺血，5 = 肯定不缺血。在定量分析中，测量对侧、同侧及大小比率。
131例患者中，54例股骨颈骨折患者中有39例（72.22%）及77例转子间骨折患者中有23例（29.87%）显示股骨头缺血。股骨颈骨折患者的股骨头缺血发生率显著高于转子间骨折患者。虽然股骨颈骨折中股骨头缺血的发生率及严重程度随Garden分期升高而增加，但两者均与转子间骨折的AO/骨科创伤协会分类无关。此外，转子间骨折周围的骨碎片数量并非股骨头缺血的显著预测指标。
虽然骨SPECT/CT上的股骨头缺血并不直接表明缺血性坏死，但使用定性和定量参数评估股骨头缺血的发生率及严重程度可为与分类相关的临床有用信息。下一步将进行更大样本量的进一步研究以扩大骨SPECT/CT的临床作用。
