中华关节外科杂志（电子版）
中華關節外科雜誌（電子版）
중화관절외과잡지（전자판）
CHINESE JOURNAL OF JOINT SURGERY(ELECTRONIC VERSION)
2012年
2期
13-16
,共4页
蒋盘强%费胜民%赵栋%张光武
蔣盤彊%費勝民%趙棟%張光武
장반강%비성민%조동%장광무
股骨颈骨折%股骨头坏死%计算机体层成像
股骨頸骨摺%股骨頭壞死%計算機體層成像
고골경골절%고골두배사%계산궤체층성상
Femoral neck fracture%Femur head necrosis%Computer tomography
目的 探讨应用64排螺旋CT薄层增强扫描技术,观察股骨颈骨折后股骨头血液循环的变化,从而为预测股骨颈骨折后股骨头缺血性坏死提供影像学依据.方法 选择2007年9月至2009年12月收治的30例股骨颈骨折患者.术前行双侧髋关节64排螺旋CT薄层增强扫描,健侧髋关节设为自身对照组.观察旋股内侧动脉、旋股外侧动脉、支持带动脉,测量双侧上述血管的管径和长度,计算比较血管容积.结果 Garden Ⅲ型股骨颈骨折患侧旋股内侧动脉、旋股外侧动脉以及头下型、基底型股骨颈骨折患侧旋股外侧动脉血管容积较健侧明显降低,差异具有统计学意义( Garden Ⅲ型旋股内侧动脉t=-2.379,P＜0.05；Garden Ⅲ型旋股外侧动脉t=-3.052,P＜0.05；头下型旋股外侧动脉t=-2.578,P ＜0.05；基底型旋股外侧动脉t=-7.908,P ＜0.05).Garden Ⅰ型、Garden Ⅱ型以及经颈型骨折双侧血管容积比较,差异无统计学意义.Garden Ⅰ型、Garden Ⅱ型、Garden Ⅲ型股骨颈骨折3组间对比,各组患侧血管容积差异无统计学意义.头下型、经颈型、基底型股骨颈骨折3组间对比,各组患侧血管容积之间差异无统计学意义.支持带动脉因CT分辨率不足未能完全显示.结论 股骨颈骨折可改变旋股内侧动脉和旋股外侧动脉血管容积,从而影响股骨头的血液循环状态,是股骨颈骨折后发生股骨头缺血坏死的病理基础之一.64排螺旋CT薄层增强扫描技术是一种直接、实时、无创的观察股骨头血液循环的方法,对评价股骨头血运,预测股骨颈骨折预后及选择治疗方案有一定的参考价值.由于CT分辨率不足,不能清晰显示及测量支持带动脉的血管容积,使其临床应用价值受到一定的局限.
目的 探討應用64排螺鏇CT薄層增彊掃描技術,觀察股骨頸骨摺後股骨頭血液循環的變化,從而為預測股骨頸骨摺後股骨頭缺血性壞死提供影像學依據.方法 選擇2007年9月至2009年12月收治的30例股骨頸骨摺患者.術前行雙側髖關節64排螺鏇CT薄層增彊掃描,健側髖關節設為自身對照組.觀察鏇股內側動脈、鏇股外側動脈、支持帶動脈,測量雙側上述血管的管徑和長度,計算比較血管容積.結果 Garden Ⅲ型股骨頸骨摺患側鏇股內側動脈、鏇股外側動脈以及頭下型、基底型股骨頸骨摺患側鏇股外側動脈血管容積較健側明顯降低,差異具有統計學意義( Garden Ⅲ型鏇股內側動脈t=-2.379,P＜0.05；Garden Ⅲ型鏇股外側動脈t=-3.052,P＜0.05；頭下型鏇股外側動脈t=-2.578,P ＜0.05；基底型鏇股外側動脈t=-7.908,P ＜0.05).Garden Ⅰ型、Garden Ⅱ型以及經頸型骨摺雙側血管容積比較,差異無統計學意義.Garden Ⅰ型、Garden Ⅱ型、Garden Ⅲ型股骨頸骨摺3組間對比,各組患側血管容積差異無統計學意義.頭下型、經頸型、基底型股骨頸骨摺3組間對比,各組患側血管容積之間差異無統計學意義.支持帶動脈因CT分辨率不足未能完全顯示.結論 股骨頸骨摺可改變鏇股內側動脈和鏇股外側動脈血管容積,從而影響股骨頭的血液循環狀態,是股骨頸骨摺後髮生股骨頭缺血壞死的病理基礎之一.64排螺鏇CT薄層增彊掃描技術是一種直接、實時、無創的觀察股骨頭血液循環的方法,對評價股骨頭血運,預測股骨頸骨摺預後及選擇治療方案有一定的參攷價值.由于CT分辨率不足,不能清晰顯示及測量支持帶動脈的血管容積,使其臨床應用價值受到一定的跼限.
목적 탐토응용64배라선CT박층증강소묘기술,관찰고골경골절후고골두혈액순배적변화,종이위예측고골경골절후고골두결혈성배사제공영상학의거.방법 선택2007년9월지2009년12월수치적30례고골경골절환자.술전행쌍측관관절64배라선CT박층증강소묘,건측관관절설위자신대조조.관찰선고내측동맥、선고외측동맥、지지대동맥,측량쌍측상술혈관적관경화장도,계산비교혈관용적.결과 Garden Ⅲ형고골경골절환측선고내측동맥、선고외측동맥이급두하형、기저형고골경골절환측선고외측동맥혈관용적교건측명현강저,차이구유통계학의의( Garden Ⅲ형선고내측동맥t=-2.379,P＜0.05；Garden Ⅲ형선고외측동맥t=-3.052,P＜0.05；두하형선고외측동맥t=-2.578,P ＜0.05；기저형선고외측동맥t=-7.908,P ＜0.05).Garden Ⅰ형、Garden Ⅱ형이급경경형골절쌍측혈관용적비교,차이무통계학의의.Garden Ⅰ형、Garden Ⅱ형、Garden Ⅲ형고골경골절3조간대비,각조환측혈관용적차이무통계학의의.두하형、경경형、기저형고골경골절3조간대비,각조환측혈관용적지간차이무통계학의의.지지대동맥인CT분변솔불족미능완전현시.결론 고골경골절가개변선고내측동맥화선고외측동맥혈관용적,종이영향고골두적혈액순배상태,시고골경골절후발생고골두결혈배사적병리기출지일.64배라선CT박층증강소묘기술시일충직접、실시、무창적관찰고골두혈액순배적방법,대평개고골두혈운,예측고골경골절예후급선택치료방안유일정적삼고개치.유우CT분변솔불족,불능청석현시급측량지지대동맥적혈관용적,사기림상응용개치수도일정적국한.
Objective To evaluate the arterial changes of femoral head after the femoral neck fracture and provide imaging proof for predicting the avascular necrosis of the femoral head (ANFH) with 64-slice spiral CT.Methods From Sep 2007 to Dec 2009,30 patients with femoral neck fracture were included.Both sides of femurs were examined by 64-slice spiral CT,and the normal sides were set as the control group. The main blood supply of the femoral head was observed, including medial femoral circumflex artery,lateral femoral circumflex artery,and retinacular arteries.The volumes of the arteries were calculated and compared.Results As for Garden type Ⅲ,there were significant differences in the volumes of medial femoral circumflex arteries and lateral femoral circumflex arteries between the two sides (P ＜0.05); as for subcapital fracture and basal-type fracture,there were significant differences in the volumes of lateral femoral circumflex arteries between the two sides ( P ＜ 0.05 ).There was no significant difference in blood supply of Garden type Ⅰ,Garden type Ⅱ and transcerical fractures.There was no significant difference in blood supply according to Garden types or fracture sites.Because of the low distinguishability,the retinacular arteries were not showed in CT.Conclusions The femoral neck fracture,as one of the pathological bases of ANFH,can change the volume of the medial femoral circumflex arteries and lateral femoral circumflex arteries,thus influence the blood circulation of the femoral head.It shoud be a direct,real time and noninvasive method to detect the perfusion of femoral head with 64-slice spiral CT and will have a good clinical significance in assessing the blood supply of femoral head,predicting prognosis and instructing treatment.But it couldn' t show the retinacular arteries clearly enough nor measure the volume of them,so its clinical application is restricted.
