DCE-MRI参数对股骨颈骨折患者术后股骨头坏死的评估

Evaluation of DCE-MRI Parameters for Postoperative Femoral Head Necrosis in Patients with Femoral Neck Fractures

本研究探讨股骨颈骨折患者采用动态对比增强磁共振成像(DCE-MRI)评估股骨头血供的价值及与患者术后并发股骨头坏死的关系。选取152例股骨颈骨折患者进行回顾性研究,根据患者术后12个月内是否发生股骨头坏死进行分组,其中,130例未发生股骨头坏死患者为非坏死组,22例发生股骨头坏死患者为坏死组。所有患者于术前、术后5 d、术后3个月分别接受了DCE-MRI检查。坏死组患者在术后5 d、术后3个月的患侧外上及内上象限同一个感兴趣区(ROI)的达峰时间均高于非坏死组患者(P<0.05);年龄增大、术前牵引、Garden分型为Ⅳ型、术后5 d外上象限或内上象限的达峰时间延长是股骨颈骨折患者术后发生股骨头坏死的独立危险因素(P<0.05),术后接受专业康复是患者发生股骨头坏死的保护性因素(P<0.05)。DCE-MRI在评估手术后发生股骨头坏死具有一定的价值,对于临床早期诊断并及时采取干预措施具有指导意义。

This study investigated the value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) in evaluating the blood supply of the femoral head in patients with femoral neck fracture and its relationship with postoperative complications of femoral head necrosis. A retrospective study of 52 patients with femoral neck fractures was selected, and the patients were grouped according to whether they had femoral head necrosis within 12 months after surgery. Among them, 130 cases without femoral head necrosis were classified as non-necrosis group, and 22 cases with femoral head necrosis were classified as necrosis group. All patients underwent DCE-MRI before surgery, 5 days after surgery, and 3 months after surgery. The peak time of the same region of interest(ROI) in the upper outer and inner upper quadrant of the affected side in the necrosis group was higher than that in the non-necrosis group at 5 days and 3 months after operation(P<0.05). Increased age, preoperative traction, Garden classification type IV, and prolonged peak time of upper outer quadrant or upper inner quadrant 5 days after operation were independent risk factors for postoperative femoral head necrosis in patients with femoral neck fracture(P<0.05). Postoperative professional rehabilitation was a protective factor for patients with femoral head necrosis(P<0.05). DCE-MRI has a certain value in evaluating the occurrence of femoral head necrosis after surgery, and it has a guiding significance for early clinical diagnosis and timely intervention measures.