What tests are needed for femoral head necrosis

What tests are needed for femoral head necrosis?

Femoral head necrosis examination:

Femoral head necrosis is diagnosed through medical history inquiry, clinical examination, X-ray, magnetic resonance imaging (MRI), radionuclide scanning, and computed tomography (CT).

1. Clinical diagnosis should be based on a careful history of injury to the hip joint, use of corticosteroids, alcohol consumption, or anemia. Clinical symptoms should clarify the relationship between the location and nature of pain and weight bearing. Physical examination should include hip rotation.

2. X-ray film: Early stage 0 and stage I ONFH are difficult to diagnose, while the above lesions can show positive changes such as sclerotic bands and transparency, cystic changes, spot sclerosis, subchondral fractures, femoral head collapse, etc. It is recommended to use the anteroposterior and frog-style lateral views of both hips, the latter of which can more clearly show the changes in the necrotic area of ​​the femoral head.

3. The T1-weighted phase changes of typical ONFH on MRI are the residual epiphyseal line of the femoral head, the winding low-signal area close to or crossing the epiphyseal line, and the low-signal band surrounding the high-signal area or mixed-signal area. The T double-line sign may appear.

4. Nuclear scanning Nuclear scanning has high sensitivity and low specificity for diagnosing early ONFH. If there is a cold area in the hot area, it can be diagnosed with a 99-technetium diphosphonate scan. However, the hot area of ​​the simple nuclear concentration should be differentiated from other hip diseases. This examination can be used to screen lesions and find multiple necrotic foci. The sensitivity of single photon emission layer imaging SPECT can be enhanced, but the specificity is still not high.

5. CT For stage II and III lesions, CT examination can clearly show the boundary, area, sclerosis zone, lesion repair and subchondral bone of the necrotic focus. The clarity and positive rate of CT in showing subchondral fractures are better than MRI and X-ray two-dimensional reconstruction, which can show the overall situation of the coronal position of the femoral head. CT scanning helps to identify lesions and choose treatment methods.