Department of Radiology, Division of Emergency Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02215, USA.
Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02215, USA.
Emerg Radiol. 2021 Apr;28(2):317-325. doi: 10.1007/s10140-020-01870-6. Epub 2020 Nov 11.
A focused hip MRI (FHMR) for the detection of radiographically occult hip fractures was implemented in our emergency department (ED) in 2013. The goal of this study was to assess the clinical utility of this protocol.
We retrospectively reviewed radiology reports of 262 unique patients who underwent 263 FHMR (coronal T1, coronal STIR, axial T2 fat saturated) for suspected hip fracture in the ED from October 2013 to March 2020. Electronic medical records were reviewed for the ED course, follow-up imaging, and clinical management within 90 days.
Seventy-one patients had one or more fractures identified by FHMR: one-third had proximal femoral fractures; two-third had pelvic fractures. Of these 71 patients, 53 (74%) had radiographically occult fractures, including 14 (20%) with occult proximal femoral fractures; 4 patients had fractures occult on CT. Nineteen patients with a suspected fracture on radiography were found to have no fracture on FHMR. Four fractures not reported on FHMR were later seen on follow-up imaging: these included 1 isolated greater trochanter, 1 additional ischial tuberosity, 1 additional superior pubic ramus, and 1 additional sacrum. All four fractures were treated non-operatively. Muscle/tendon injury was the most common type of injury, seen in 50% (130/262) patients with the most commonly torn tendons being the hamstring (44%; 15/34) followed by gluteus medius tendon (18%; 6/34). A full-hip or pelvis MRI was done after FHMR in only 5 patients, primarily for the purpose of better characterizing findings already identified on FHMR (2 for fracture, 2 for tendon injury, 1 for soft tissue metastasis). Only one of these five studies provided new information: ruling out a previously questioned fracture. Clinical management of the vast majority of patients was based solely on findings from the FHMR.
FHMR offers reliable identification of radiographically occult hip fractures and muscle/tendon injuries. The protocol is well trusted in guiding patient management in our ED.
2013 年，我们在急诊科实施了针对影像学隐匿性髋部骨折的焦点髋关节 MRI（FHMR）。本研究旨在评估该方案的临床实用性。
我们回顾性分析了 2013 年 10 月至 2020 年 3 月期间因疑似髋部骨折在急诊科行 263 次 FHMR（冠状 T1、冠状 STIR、轴位 T2 脂肪饱和）的 262 名患者的放射学报告。电子病历用于评估 ED 病程、90 天内的随访影像学和临床管理。
71 名患者的 FHMR 发现一处或多处骨折：三分之一为股骨近端骨折；三分之二为骨盆骨折。在这 71 名患者中，53 名（74%）有影像学隐匿性骨折，包括 14 名（20%）隐匿性股骨近端骨折；4 名患者 CT 显示骨折隐匿。19 名 X 线片疑似骨折的患者在 FHMR 上未见骨折。4 处 FHMR 未报告的骨折在随访影像学上后来被发现：包括 1 处孤立的大转子、1 处额外的坐骨结节、1 处额外的耻骨上支和 1 处额外的骶骨。所有 4 处骨折均采用非手术治疗。肌肉/肌腱损伤是最常见的损伤类型，262 名患者中有 50%（130/262）出现这种损伤，最常撕裂的肌腱是腘绳肌（44%；15/34），其次是臀中肌肌腱（18%；6/34）。只有 5 名患者在 FHMR 后进行了全髋关节或骨盆 MRI，主要是为了更好地描述 FHMR 已经发现的发现（2 例骨折，2 例肌腱损伤，1 例软组织转移）。这 5 项研究中只有一项提供了新的信息：排除了之前有疑问的骨折。绝大多数患者的临床管理仅基于 FHMR 的发现。
FHMR 可可靠地识别影像学隐匿性髋部骨折和肌肉/肌腱损伤。该方案在指导我们急诊科的患者管理方面具有良好的可信度。
