整形１１

【臨床症状】

【問題】画像所見と診断名は？

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➡ MRI画像
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※T2WI、脂肪抑制冠状断、T2WI横断像の順に表示

    ▶答えはこちら
    • CTで右大腿骨大転子に骨皮質の連続性が途切れる骨折線を認め、転子部骨折が疑われる
    • MRIでも同部位に骨髄浮腫と骨折線を認め、大腿骨転子部骨折と診断できる
    • またMRIでは周囲軟部組織に、挫傷や出血による腫脹を認める
    • 右大腿骨転子部骨折と診断された

    【大腿部転子部骨折】

    ・大腿骨近位部骨折の一つ

    ・80歳以上の大腿骨近位部骨折は、頚部骨折と比較して転子部骨折の方が多い ¹⁾

    ・また転子部骨折では、受傷前歩行能力の獲得や自宅退院率が低いとも言われている

    ・重症度分類にはEvans分類がよく使われている

    • 骨折が安定型か不安定型かなどで分類され、Type1とType2がある
    • その中でもType1は転位の有無、粉砕骨折の有無でGroup1～4に分類される
    1） Committee for Osteoporosis Treatment of The Japanese Orthopaedic Association． Nationwide survey of hip fractures in Japan．J Orthop Sci 9：1-5，2004