螺旋CT评价股骨颈骨折后股骨头血运的临床研究  

Clinical evaluation of the blood supply in femoral head after femoral neck fracture by spiral CT

作　　者：蒋盘强[1] 费胜民[1] 赵栋[1] 张光武[1] 

机构地区：[1]北京大学首钢医院骨科,100144

出　　处：《中华关节外科杂志（电子版）》2012年第2期13-16,共4页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：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 GardenⅢ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(GardenⅢ型旋股内侧动脉t=-2.379,P<0.05;GardenⅢ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)。GardenⅠ型、GardenⅡ型以及经颈型骨折双侧血管容积比较,差异无统计学意义。GardenⅠ型、GardenⅡ型、GardenⅢ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。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.ResultsAs 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（P0.05）;as for subcapital fracture and basal-type fracture,there were significant differences in the volumes of lateral femoral circumflex arteries between the two sides（P0.05）.There was no significant difference in blood supply of Garden typeⅠ,Garden typeⅡ 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.

关 键 词：股骨颈骨折 股骨头坏死 计算机体层成像 

分 类 号：R687.3[医药卫生—骨科学]