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1、MRIEvaluationofCollapsed FemoralHeadsinPatients 60YearsOldorOlder: DifferentiationofSubchondralInsufficiencyFractureFromOsteonecrosisoftheFemoralHead2011.4.17FromAJR:195,July2010WordsSubchondralInsufficiencyFracture：软骨下不全骨折OsteonecrosisoftheFemoralHead：股骨头坏死Convex凸ncavity凹软骨下不全骨折（Subchondrali
2、nsufficiencyfracture,简称SIFs）1、软骨下机能不全性骨折是非外伤性的一种骨折。2、最常见的病因：骨质疏松，不常见的病因是骨质软化症或骨不全症、甲状旁腺功能亢进和类风湿性关节炎等。3、发病原理：正常软骨可忍受正常的生物机械应力，当由于上述病因变得软弱时，可出现软骨下骨折，并发展为软骨下萎陷，为此需认识此病作出早期诊断，多数患者经保守治疗后可自愈。OBJECTIVEThepurposeofthisarticleistoverifythehypothesisthatosteonecrosisandsubchondralinsufficiencyfractureo
3、fthefemoralheadcanbedifferentiatedonthebasisoftheirappearanceonMRI.SUBJECTSANDMETHODS1BetweenMay1998andFebruary2009,wereviewed30consecutivehipsin30patients,60yearsoldorolderatthetimeofonsetofhippain,withradiologicevidenceofsubchondralcollapseofthefemoralheadandwithbothMRimagesandhistologicres
4、ultsavailable.SUBJECTSANDMETHODS2Thepatientsweredividedintotwogroupaccordingtotheshapeoflow-intensitybandsonT1-weightedimages.Thefirstgroupshowedconcavityofthearticularsurface,whichischaracteristicofosteonecrosis,andthesecondgroupshowedanirregularconvexityofthearticularsurface,whichischaracte
5、risticofsubchondralinsufficiencyfracture.AInosteonecrosis,low-intensitybandissmooth,concavetoarticularsurface,andcircumscribesallofnecroticsegments.BInsubchondralinsufficiencyfracture,low-intensitybandisirregular,convextoarticularsurface,anddiscontinuous.RESULTSSixteenhips(53.3%)showedevidenc
6、eofosteonecrosis,and14(46.7%)showedevidenceofsubchondralinsufficiencyfracture,whichwasconsistentwiththecorrespondinghistopathologicdiagnoses.Inallcasesofosteonecrosis,thepatienthadahistoryofeithercorticosteroidintakeoralcoholabuse.Amongpatientswithsubchondralinsufficiencyfracture,theproportio
7、nofwomenwassignificantlyhigherthanthatamongpatientswithosteonecrosis.Acrescentsign(subchondralfracture)waspresentradiographicallyinabouthalfofallcasesinbothgroups.TABLE1:ClinicalCharacteristicsofPatientsWithOsteonecrosisorSubchondralInsuffici
