MRI对股骨颈骨折术后并发股骨头坏死早期诊断的临床研究

摘要

目的：研究MRI对股骨颈骨折（TF）术后并发股骨头坏死（ONFH）早期诊断的临床价值。方法2007年2月~2012年3月共计86例共86髋患者被确诊为TF术后合并ONFH。分别于术后不同时期进行MRI以及X线片检查，对比诊断敏感性及随时间变化的ONFH进展情况。结果 MRI检查在3个月内敏感性为17.44%（15/86），4～6个月敏感性为19.77%（17/86），7～9个月敏感性为26.74%（23/86），10～12个月敏感性为18.60%（16/86），均显著高于X线片检查的6.98%（6/86）、8.14%（7/86）、13.95%（12/86）、8.14%（7/86），差异均有统计学意义（P均＜0.05）。MRI检查与X线片检查在13个月以上的敏感性差异无统计学意义（P＞0.05）。随着时间的变化，TF术后合并ONFH在MRI检查过程中，发现放射前期的平均时间为7.64±4.29个月，发现其塌陷前的平均时间为15.88±7.74个月，发现塌陷期的平均时间为17.61±11.68个月，发现骨关节炎期的平均时间为17.64±12.59个月。结论 TF病患术后3个月内即可实施常规MRI检查，以排除并发有ONFH可能。在术后12个月内MRI诊断价值显著高于X线片，即MRI应用于早期ONFH作用十分明显，但进入Ⅳ期后，X线片诊断结果基本接近MRI，因此亦可加以选用。%Objective To study the clinical condition of early-stage diagnosis of MRI for postoperative ONFH (osteonecrosis of femoral head) of TF (transcervical fracture). Methods 86 cases (86 hips) diag-nosed with postoperative ONFH of TF were given MRI and X ray examinations on different stages after opera-tion, diagnostic sensibility and ONFH progress condition changes along with the time were compared. Results Sensibility within 3 months of MRI was 17.44%(15/86), 4 to 6 months was 19.77%(17/86), 7 to 9 months was 26.74%(23/86), 10 to 12 months was 18.60%(16/86), all obviously higher than X ray 6.98%(6/86), 8.14%(7/86), 13.95%(12/86), 8.14% (7/86),P<0.05. Sensibility of MRI and X ray above 13 months were not statistically different, P>0.05. Along with the time, during examination of MRI for postoperative ONFH of TF, discovery time of early stage of radiation was on average 7.644.29 months, discovery time of early stage of collapse was on average 15.887.74 months, discovery time of collapse stage was on average 17.6111.68 months, discovery time of osteoarthritis stage was on average 17.6412.59 months. Conclusion MRI examination can be used within 3 months after TF opeartion to rule out possibility of ONFH. Diagnostic value of MRI is higher than X ray within 12 months after operation, in other words, it has obvious effect on early stage. But when enteringⅣstage, diagnostic result of X ray is simi-lar to MRI, so both could be used depending on condition.