Schmaranzer F, Lerch T D, Steppacher S D, Siebenrock K A, Schmaranzer E, Tannast M
Department of Orthopaedic Surgery, Inselspital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland.
Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital Bern, University of Bern, Freiburgstrasse 3010 Bern, Switzerland.
J Hip Preserv Surg. 2021 Jun 17;8(1):28-39. doi: 10.1093/jhps/hnab038. eCollection 2021 Jan.
The primary purpose was to answer the following question: What is the location and pattern of necrosis and associated chondrolabral lesions and can they be accurately detected on traction MR arthrography compared with intra-operative findings in patients undergoing hip preservation surgery for femoral head necrosis (FHN)? Retrospective, diagnostic case series on 23 patients (23 hips; mean age 29 ± 6 years) with diagnosis of FHN undergoing open/arthroscopic joint preserving surgery for FHN and pre-operative traction MR arthrography of the hip. A MR-compatible device for weight-adapted application of leg traction (15-23 kg) was used and coronal, sagittal and radial images were acquired. Location and pattern of necrosis and chondrolabral lesions was assessed by two readers and compared with intra-operative findings to calculate diagnostic accuracy of traction MR arthrography. On MRI all 23 (100%) hips showed central FHN, most frequently antero-superiorly (22/23, 96%) where a high prevalence of femoral cartilage damage was detected (18/23, 78%), with delamination being the most common (16/23, 70%) damage pattern. Intra-operative inspection showed central femoral head cartilage damage most frequently located antero-superiorly (18/23, 78%) with femoral cartilage delamination being most common (14/23, 61%). Traction MR arthrography enabled detection of femoral cartilage damage with a sensitivity/specificity of 95%/75% for reader 1 and 89%/75% for reader 2. To conclude, femoral cartilage damage occurs at the zone of necrosis and can be accurately detected using traction MR arthrography of the hip which may be helpful for surgical decision making in young patients with FHN.
对于因股骨头坏死（FHN）接受髋关节保留手术的患者，坏死的位置和模式以及相关的盂唇病变是什么，与术中发现相比，牵引磁共振关节造影能否准确检测到这些病变？对23例诊断为FHN且因FHN接受开放/关节镜下关节保留手术以及术前髋关节牵引磁共振关节造影的患者进行回顾性诊断病例系列研究。使用了一种与磁共振兼容的用于腿部重量适应性牵引（15 - 23千克）的装置，并采集了冠状位、矢状位和放射状图像。由两名阅片者评估坏死和盂唇病变的位置和模式，并与术中发现进行比较，以计算牵引磁共振关节造影的诊断准确性。在磁共振成像上，所有23例（100%）髋关节均显示中央型FHN，最常见于前上方（22/23，96%），在此处检测到股骨软骨损伤的发生率较高（18/23，78%），分层是最常见的（16/23，70%）损伤模式。术中检查显示股骨头中央软骨损伤最常见于前上方（18/23，78%），股骨软骨分层最为常见（14/23，61%）。牵引磁共振关节造影对股骨软骨损伤的检测，阅片者1的敏感度/特异度为95%/75%，阅片者2为89%/75%。总之，股骨软骨损伤发生在坏死区域，使用髋关节牵引磁共振关节造影可以准确检测到，这可能有助于FHN年轻患者的手术决策。
