Department of Orthopaedic Surgery, The Catholic University of Korea, Bucheon, Republic of Korea.
Hip Int. 2020 Sep;30(5):641-648. doi: 10.1177/1120700019860492. Epub 2019 Jul 7.
To evaluate the predicting value of Tc-hydroxydiphosphonate (HDP) pinhole bone scan in development of osteonecrosis of femoral head (ONFH) in patients with femoral neck fracture after cannulated screw fixation.
Pinhole bone scan of patients with metallically fixed femoral neck fracture from 2001 to 2015 were retrospectively reviewed. Initial pinhole bone scan was obtained within 2-3 weeks after surgery. Findings of initial pinhole bone scan were divided in to 4 groups. Group CU included cold defect in affected femoral head, group HU with no cold defect. Group PP with increased uptake along the inserted screws and group PN with no increased uptake along the inserted screws. More than 6 months of follow-up with pinhole bone scan and clinico-radiological evidence for ONFH was reviewed.
72 patients (mean age 54.01 years, male 22, female 50) were included. 19 patients were in group CU, 53 in group HU. 60 patients were in group PP, 12 in group PN. During the follow-up, 13 patients were diagnosed as ONFH. 9 (47.36%) patients in group CU developed ONFH and 4 (7.5%) in group HU. 4 (6.66%) patients in group PP developed ONFH and 9 (75%) in group PN.
To predict ONFH of femoral head followed by neck fracture, many imaging techniques with variable results were known. In this study, cold defect in early postoperative pinhole bone scans could predict ONFH, and loss of increased uptake along screw inserted site could be a strong indicative sign of ONFH. Further evaluation with a larger population is necessary.
评估 Tc-羟膦酸盐（HDP）骨闪烁扫描在空心钉固定股骨颈骨折后预测股骨头坏死（ONFH）的价值。
回顾性分析 2001 年至 2015 年接受金属内固定的股骨颈骨折患者的骨闪烁扫描。术后 2-3 周内进行初次骨闪烁扫描。将初次骨闪烁扫描结果分为 4 组：CU 组为患侧股骨头冷缺损，HU 组无冷缺损，PP 组螺钉插入部位有放射性摄取增加，PN 组无放射性摄取增加。对所有患者进行至少 6 个月的随访，观察是否有骨闪烁扫描和临床放射学证据表明发生 ONFH。
72 例患者（平均年龄 54.01 岁，男性 22 例，女性 50 例）被纳入研究。19 例患者在 CU 组，53 例在 HU 组；60 例患者在 PP 组，12 例在 PN 组。随访期间，13 例患者被诊断为 ONFH。CU 组中 9 例（47.36%）发生 ONFH，HU 组中 4 例（7.5%）发生 ONFH；PP 组中 4 例（6.66%）发生 ONFH，PN 组中 9 例（75%）发生 ONFH。
为了预测股骨颈骨折后继发的股骨头坏死，已经有许多影像学技术，但结果各不相同。在本研究中，术后早期骨闪烁扫描的冷缺损可预测 ONFH，而螺钉插入部位放射性摄取的丧失可能是 ONFH 的强烈指示性征象。需要进一步对更大的人群进行评估。
