术前骨扫描在股骨颈骨折手术方式选择中得作用.pptx

The role of preoperative bone scan for determining the treatmentmethod for femoral neck fractureInternational Orthopaedics(SICOT)(2007)31:6164AbstractTo evaluate the role of preoperative bone scintigraphy in determining the operative treatment method for femoral neck fracture,we reviewed the data of 83 patients who underwent preoperative bone scanning after femoral neck fracture.Fractures were classified using the Garden staging system.Radioisotope uptake in femoral heads was evaluated visually.IntroductionFemoral neck fracture is still known as“unsolved fracture”because it is frequently complicated by avascular necrosis or non-union.Blood supply to the femoral head can be disturbed by a femoral neck fracture due to anatomical characteristics,and this is considered to be a major cause of non-union or avascular necrosis of the femoral head.In this study,we evaluated the role of preoperative bone scan for determining the operative method for femoral neck fracture.Materials and methodsBetween January 1998 and December 2003,a total of 83 patients with femoral neck fracture had a preoperative bone scintigram.They were 21 men and 62 women with an average age of 67.0 years(range,1893 years).Preoperative bone scanning was performed using 99mTc-MDP.a Radioisotope uptake is reduced in both anterior and posterior views(category R:overall reduction in activity).b Radioisotope uptake is reduced in the anterior or posterior view(category P:partial reduction in activity).c Radioisotope uptake is normal or increased(category N:normal orincreased activity)ResultsIn general,preoperative radioisotope uptake in the femoral head on the fractured side corresponded with the degree of fracture displacement.This is the only case in this series in which the operative method was changed because of bone scan findings.In three cases with radioisotope uptake of N,replacement arthroplasty was performed because of their age(74,80 and 87).DiscussionMany studies have reported that 99mTc-MDP bone scans are useful for assessing the prognosis of femoral neck fractures.Catto suggested that a displaced fracture has a poorer prognosis than a non-displaced fracture because blood supply to the femoral head is decreased 2.Degree of fracture displacement and patient age areimportant factors when deciding on the method of operation 13.SummaryWe are forced to conclude that preoperative bone scan has no significant role in deciding on operative method in cases of femoral neck fracture.Degree of fracture displacement and patient age areimportant factors when deciding on the method ofoperation.One study found that blood flow improves afteranatomical reduction of a displaced femoral neckfracture,and recommended anatomical reductionto reduce complications.Thank you!