股骨颈骨折后股骨头坏死与塌陷的临床预测

Clinical Prediction for Necrosis and Collapse of Femoral Head after Femoral Neck Fracture

介绍用内固定治疗的股骨颈骨折３１例，伤后早期行放射性核素骨显像检查，术中经钉道取股骨头外上区骨组织进行组织学检查。二种方法对照比较，定量分析股骨头缺血坏死的程度，３１例中有２８例获２年以上随访。研究发现，骨折明显移位者，其骨显像摄取比较低，组织学坏死较重。根据组织学坏死程度分组，小灶性坏死组平均摄取比为１．７３，部分性坏死组摄取比为１．０２，广泛性坏死组摄取比为０．６８。１１例广泛性坏死组中，有９例属于ＧａｒｄｅｎⅣ期。骨显像检查和组织学检查结果的符合率为９３．５％。随访发现，组织学坏死程度低，预后较好；坏死程度较重，如能获得良好的组织学修复结局亦满意。

Thirty-one patients of femoral neck frture treated with internal fixation were examined by preoperative radionucl ide bone imaging (99mTc-MDP), and biospy taken the superiolateral region of femoral head, Using the two methods , the severity of avascular necrosis of the femoral head was assessed quantitaticely, of the 31 patients,28 were followedup over 2 years. The results revealed that the severer the fracture displacement, the lower the uptake ratio of the bone imaging and the more extensive the histological necrosis of the head. The mean uptake ratio was 1.73 in the group with minimal necrosis, 1.02 in the group with partial necrosis and 0.68 in the group with extensive necrosis. The accuracy ratio between the results of the bone imaging and histological examination was 93.5%, which showed that the severity of avascalar necrosis of femoral head could be determined by means of the bone imaging. The results of clinical follow up for segmental collapse presented that the prognosis was better in the group with minimal necrosis. The satisfactory result may be found in the patient with extensive necrosis when the histological repairing process is rapid and complete.