老年隐匿性股骨颈骨折磁共振成像早期诊断和治疗

目的探讨磁共振成像(MRI)在早期诊断和治疗老年隐匿性股骨颈骨折中的应用价值。方法老年外伤后髋部疼痛临床怀疑股骨颈骨折而X线平片阴性的病例行MRI检查共32例,对这些病例的病史、放射学资料、治疗措施和随访疗效进行整理。结果MRI显示股骨颈骨折20例,股骨转子间骨折2例,耻骨支骨折1例,髋关节周围软组织损伤6例,阴性3例。22例髋部骨折患者中,13例进行了3枚空心加压螺钉治疗,9例非手术治疗。所有患者进行了6～24个月的随访。手术治疗组患者恢复良好,未出现骨折不愈合或股骨头坏死,非手术治疗组患者中2例出现骨折移位行人工股骨头置换术。MRI显示没有髋部骨折的10例在随访过程中复查X线片均呈阴性。结论老年人髋部外伤后疼痛临床怀疑股骨颈骨折而X线平片阴性时,髋关节MRI检查值得推荐以免延误诊治。

Application of Magnetic Resonance Imaging in Senile Occult Femoral Neck Fractures

Objective To investigate the application of magnetic resonance imaging(MRI) in the early diagnosis and treatment of occult femoral neck fractures in elderly patients.Methods In a prospective study from January 2003 to June 2005,all patients with negative or equivocal radiographs but clinically suspected of femoral neck fracture were examined by MRI.Results Thirty-two consecutive patients(25 women) were included,with an average age of 79.6 years old ranging from 67 to 91 years old.In these patients,20 patients were found femoral neck fractures,2 intertrochanteric fractures,1 pubic rami fracture,6 soft tissue injuries and 3 negative images.Thirteen patients were fixed with three Titanium cannulated screws and 9 received conservative treatment.Follow-up lasted at least 6 months.All the operative patients got good functional recovery while 2 conservative members developed displaced fractures.Ten patients without fracture on MRI were followed up and negative X-ray was found in the study period.Conclusion In all patients with negative or equivocal radiographs but clinically suspected of femoral neck fracture,MRI is recommended as early as possible.