Poggi J J, Callaghan J J, Spritzer C E, Roark T, Goldner R D
Division of Orthopaedics, Ehrling-Bergquist Hospital, Offutt Air Force Base, NE, USA.
Clin Orthop Relat Res. 1995 Oct(319):249-59.
Fourteen patients with traumatic hip dislocation had serial magnetic resonance imaging and routine radiographic studies from the time of injury through 24 months after injury. One experienced radiologist interpreted all images prospectively for abnormalities suggesting osteonecrosis of the femoral head and posttraumatic arthritis. Eight hips demonstrated abnormal marrow signals on T1 and T2 weighted images within 6 weeks of injury. These changes progressed in 3 hips, and osteonecrosis was confirmed subsequently by plain radiography. The abnormal marrow signals in the remaining 5 hips proved to be transient, resolving on magnetic resonance images within 3 months in 4 of the 5 patients. Magnetic resonance imaging can be used with confidence for the early detection of osteonecrosis of the femoral head after traumatic hip dislocation or fracture-dislocation. The presence of acetabular or femoral shaft hardware did not preclude magnetic resonance imaging assessment of these patients when coronal, sagittal, and axial images were obtained. Magnetic resonance imaging was not reliable for assessing marrow changes within the first week after injury, nor was it helpful in predicting which patients were at risk for posttraumatic arthritis to develop. An algorithm is proposed for using magnetic resonance imaging in the early diagnosis of osteonecrosis of the femoral head after traumatic hip dislocation.
14例创伤性髋关节脱位患者在受伤后至伤后24个月期间接受了系列磁共振成像（MRI）检查和常规X线检查。由一名经验丰富的放射科医生对所有图像进行前瞻性解读，以发现提示股骨头缺血性坏死和创伤后关节炎的异常情况。8例髋关节在受伤后6周内T1加权像和T2加权像上显示骨髓信号异常。其中3例髋关节的这些改变持续进展，随后经X线平片证实为缺血性坏死。其余5例髋关节的异常骨髓信号被证明是短暂性的，5例患者中有4例在3个月内MRI图像上信号消失。对于创伤性髋关节脱位或骨折脱位后股骨头缺血性坏死的早期检测，MRI可放心使用。当获取冠状位、矢状位和轴位图像时，髋臼或股骨干内固定物的存在并不妨碍对这些患者进行MRI评估。MRI在伤后第一周内评估骨髓变化不可靠，对预测哪些患者有发生创伤后关节炎的风险也无帮助。本文提出了一种在创伤性髋关节脱位后股骨头缺血性坏死早期诊断中使用MRI的算法。
