Femur boyun stres kırığı BT bulguları

Özet

Femur boyun stres kırığı, tekrarlayan yüklenmenin normal kemikte oluşturduğu yorgunluk kırığı veya daha düşük yükün zayıflamış kemikte oluşturduğu yetersizlik kırığı şeklinde gelişebilir. BT, kortikal ve subkondral kemikteki ince kırık hatlarını gösterebilir; erken kemik iliği değişikliklerinin saptanmasında MRG daha duyarlıdır. Süperolateral tensiyon tarafındaki kırıklar deplasman açısından daha yüksek risk taşırken, inferomedial kompresyon tarafındaki kırıklar genellikle daha stabildir. Tanının kaçması çizginin tamamlanmasına ve deplasmanlı femur boyun kırığına ilerleme riskini gözden kaçırır.

Faz ve pencere

Kontrastsız tanısal: Tensiyon tarafı süperolateral femur boynunda; kompresyon tarafı ise inferomedial femur boynunda yerleşir ve genellikle daha stabildir. BT incelemelerinde kortikal bütünlük, alt-kortikal kırık hattı ve erken çökme ile birlikte subkondral skleroz izlenir.
Kemik algoritması tanısal: Femur boynuna paralel koronal eğik rekonstrüksiyonlarda kırık çizgisinin korteks başlangıcı ve boyun genişliği boyunca uzanımı belirginleştirilir. Kemik iliği ödemi BT ile gösterilemeyeceğinden BT negatifliği erken stres yaralanmasını dışlamaz.

Önerilen pencereler: Kemik (G 1800 / M 400).

BT bulguları

Süperolateral korteks kırığı — femur boynunun üst kısmında görülen kortikal hat tensiyon tarafını düşündürür.
İnferomedial korteks kırığı — femur boynunun alt-medial bölgesinde görülen kortikal hat ve çevresindeki sklerotik değişiklik kompresyon tarafını düşündürür.
Kortikal reaksiyon — yük taşıyan kortekste sınırlı kalınlaşma veya periostal yeni kemik.
Çizginin boyun boyunca ilerlemesi — koronal eğik planda femur boynu genişliği içindeki uzanım tarif edilir.
BT, kortikal ve subkondral kemik bütünlüğünü ve ince kırık hatlarını gösterebilir; femur boyun stres kırıkları deplase olabilir.
BT'de ödem yokluğu — kemik iliği ödemi bir BT bulgusu değildir; şüphe ve ağrı sürerken MRG ile araştırılır.

Ölçütler ve sınıflamalar

Shin-Gillingham MRG sınıflamasında kompresyon yaralanması: MRG'de femur boynu kemik iliği ödemi belirgin bir kırık hattı olmadan görülebilir; kırık hattı varsa uzanımı femur boynu genişliğinin %50'sinden az veya fazla olarak değerlendirilir.
Fullerton-Snowdy: Tip I: kompresyon tarafı (stabil); Tip II: tensiyon tarafı (yüksek deplasman riski); Tip III: deplase kırık (kortikal hizalama kaybı, yüksek komplikasyon riski).

Normalde

Erken evrede femur boyun stres kırığı radyografide çoğu kez seçilemeyebilir. Femur boynu stres kırığında kırık hattının süperolateral veya inferomedial yerleşimini ve deplasman durumunu değerlendirin.

Normal BT ile kıyasla

Aynı bölgenin, kaynak veri setinde patoloji içermediği belirtilen bir BT incelemesini kesit kesit kaydırın; organ sınırlarını açarak anatomiyi hasta görüntüsüyle karşılaştırın. Küçük rastlantısal bulgular tümüyle dışlanmamıştır.

Kaynak: TotalSegmentator v2.01 veri seti (Wasserthal ve ark., Radiology: Artificial Intelligence 2023), CC BY 4.0, vaka s1256; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Subkondral yetersizlik kırığı veya femur başı osteonekrozu: bu durumlar femur boyun stres kırığıyla benzer kalça ağrısı tablolarına ve erken görüntülemede örtüşen bulgulara yol açabilir.
Femur başı osteonekrozu: subkondral başta serpijinöz sklerotik sınır veya çökme görülür; boyun korteksinden başlayan stres çizgisi değildir.
Osteoartritte kıkırdak kaybıyla ilişkili yaygın kemik iliği lezyonları görülebilir; femur boyun stres kırığında ise femur boynundan geçen kırık hattı ve çevresinde ödem izlenebilir.
Pubik ramus stres kırığı: çizgi femur boynunda değil pubik ramus korteksindedir.
Subkondral yetersizlik kırığı: femur başı eklem yüzüne paralel/subkondral yerleşir, boyun korteksinden başlamaz.

Tuzaklar

Kompresyon tarafı kırıklar radyografik olarak çok hafif bulgular verebilir; klinik şüphe devam ediyorsa ileri görüntüleme gereklidir.
BT'de görünür kırık yokluğu erken stres reaksiyonunu dışlamaz; ağrı ve yüklenme öyküsüyle klinik şüphe sürüyorsa MRG bulgusu aranmalıdır.
Bu kaynaklarda kırık hattının uzanım yüzdesi MRG üzerinden değerlendirilmiştir.

Kendini dene

Fullerton-Snowdy sınıflamasında femur boynunun süperolateral tensiyon tarafındaki kırık hangi tiptir?
Cevabı göster
Tip II. Fullerton-Snowdy sınıflamasında Tip II tensiyon tarafı kırığıdır; süperolateral femur boynunda yerleşir.
BT’de kırık hattı görülmese de tekrarlayan koşu sonrası kasık ağrısı sürüyorsa erken kemik iliği değişikliklerini saptamada en duyarlı yöntem hangisidir?
Cevabı göster
MRG. MRG, erken kemik iliği değişikliklerini göstermede en duyarlı yöntemdir.

İlgili konular

Gizli ve yetersizlik tipi femur boyun kırığı

Kaynaklar

Bu sayfadaki 37 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 19 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.