A Clinical Study Of Bone Metabolism And Hemodynamics After Femoral Neck Fracture

Objective: Three phase bone imaging was used to study the changes of hemodynamics and bone metabolism in patients with femoral neck fracture,and to verify whether the degree of fracture displacement is consistent with the degree of radioisotope uptake of the femoral head.Through the analysis,we can provide the basis for clinicians to choose the appropriate operation mode and predict the prognosis and development of fracture.Methods: Using the retrospective analysis method,the patients who were diagnosed as femoral neck fracture in the Department of Orthopaedics and traumatology,Affiliated Hospital of Qing Hai University from December 2018 to December 2019 were selected.According to specified standards,a total of 30 subjects,including 11 males and 19 females,aged 25-80 years with an average age of 60.1 years,were selected for the study.According to Garden stage :9 cases were type Garden stage I,3 cases were type Garden stage II,8 cases were type Garden stage III,10 cases were type Garden stage IV.Three phase bone scintigraphy was performed in 30 patients with femoral neck fracture one week after fracture,four weeks after fracture treatment and 12 weeks after fracture treatment with the same imaging method and the same equipment.The blood flow phase,blood pool phase and delay phase were measured respectively.The "ROI" of the healthy side of the femoral head was made with a certain area,and then the radiation intensity was collected and processed by computer to form the time radiation intensity curve of the healthy side of the femoral head.At the same time,the radioactive counts of ROI in the delayed phase were measured.30 cases of femoral neck fracture were examined by bone three-phase examination one week after fracture to see whether it has guiding effect on the treatment plan of clinical orthopedic doctors;the data of each observation index were statistically processed,and the three-phase examination of core medical bone one week before operation was used to verify whether the radioisotope uptake intensity of the femoral head on the fracture side was consistent with the fracture classification after fracture of femoral neck After the examination,the specific ROI was selected on the blood flow image and blood pool image,and the time radiation intensity curve(T-A curve)of the bilateral femoral head of the fracture patients was established to evaluate the blood perfusion of the patients with femoral neck fracture in different periods,The bone salt metabolism level of the femoral head was estimated by calculating the radiation count ratio(head / head ratio)of the healthy side of the affected side in different periods.Results: In 30 cases of fracture,none of them changed the operation plan after the results of three-phase bone imaging.Preoperative nuclear medicine three-phase bone imaging seems to have no important role in guiding the surgical treatment of femoral neck fracture.In the radiograph of pelvis bone,the intensity of radioisotope uptake of femoral head in early fracture side after femoral neck fracture generally corresponds to the degree of displacement of fracture(garden stage).In the blood flow phase and blood pool phase,the blood flow of the femoral head in the early stage of femoral neck fracture generally has no significant change.The blood flow of the femoral head decreases 4 weeks after fracture,and the blood flow of the femoral head gradually recovers in the later stage.There was no significant difference in gender and age of patients with different garden stages after femoral neck fracture(P > 0.05);The radioisotope uptake of the femoral head in 30 patients with femoral neck fracture within one week after fracture was basically corresponding to the degree of fracture displacement and garden stage,the difference was statistically significant(P < 0.05)There were no significant changes in the blood flow of the femoral head in 1 week after fracture,4 weeks after fracture treatment,12 weeks after fracture treatment.The difference was statistically significant(P < 0.05)The head / head ratio of the affected side and the healthy side of delayed imaging was 1.02 ± 0.34,2.02 ± 0.64 and 1.05 ± 0.20 respectively in three periods,the difference was statistically significant(P < 0.05).Conclusion: In the treatment of traumatic femoral neck fracture,preoperative nuclear medicine three-phase bone imaging seems to have no important role in guiding the surgical treatment of femoral neck fracture.In general,The intensity of radioisotope uptake of the femoral head on the fracture side after femoral neck fracture generally corresponds to the degree of displacement of the fracture(Garden stage).From the early to the middle stage,the ability of absorbing radioisotopes of the femoral head is decreased because of the damage of blood vessels,the obstruction of blood supply,the decrease of blood flow and the decrease of bone salt metabolism;In the later stage,with the gradual recovery of blood supply of the femoral head,the level of bone metabolism gradually increased,and the radiation intensity of the femoral head gradually increased.