Kamano M, Narita S, Honda Y, Fukushima K, Yamano Y
Department of Orthopaedic Surgery, Baba Memorial Hospital, Osaka, Japan.
Clin Orthop Relat Res. 1998 May(350):179-86.
Femoral head perfusion was evaluated in 29 patients after acute femoral neck fracture using contrast enhanced fat saturation magnetic resonance imaging. The patients were followed up with T1 and T2 weighted spin echo magnetic resonance imaging without fat saturation, which is suitable in detecting avascular necrosis. The mean interval from injury to the initial contrast enhanced fat saturation magnetic resonance imaging was 24.5 hours. The mean age at the time of injury was 69 years, and the mean followup was 26.9 months. Three distinct patterns of femoral head enhancement were recognized in the acute phase after fracture. When the whole femoral head was well enhanced (Type 3, n = 11), no avascular necrosis developed. In contrast, when the head showed no enhancement (Type 1, n = 6), avascular necrosis developed in all patients. In patients with partial enhancement (Type 2, n = 12), avascular necrosis developed in five patients. These data showed the current method provided an accurate prediction of the development of avascular necrosis in the patients with Type 1 and Type 3 enhancement. However, overall predictive value was 59% (17 of 29 patients) because of the uncertainty in the patients with partial enhancement (Type 2), and additional study is needed for this method to become routine in clinical use.
采用对比增强脂肪抑制磁共振成像技术，对29例急性股骨颈骨折患者的股骨头灌注情况进行了评估。对患者进行了不带有脂肪抑制的T1加权和T2加权自旋回波磁共振成像随访，这种成像方式适合检测缺血性坏死。从受伤到初次对比增强脂肪抑制磁共振成像的平均间隔时间为24.5小时。受伤时的平均年龄为69岁，平均随访时间为26.9个月。骨折后的急性期，识别出了三种不同的股骨头强化模式。当整个股骨头强化良好时（3型，n = 11），未发生缺血性坏死。相反，当股骨头无强化时（1型，n = 6），所有患者均发生了缺血性坏死。在部分强化的患者中（2型，n = 12），有5例发生了缺血性坏死。这些数据表明，目前的方法能够准确预测1型和3型强化患者缺血性坏死的发生情况。然而，由于部分强化患者（2型）情况的不确定性，总体预测价值为59%（29例患者中的17例），该方法要成为临床常规应用还需要进一步研究。
