Femur patolojik kırığı

Özet

Femur patolojik kırığı, tümör, enfeksiyon veya metabolik kemik hastalığıyla zayıflamış kemikte düşük enerjili travma ya da olağan yüklenme sonrasında gelişebilir; metastatik odaklar önemli nedenler arasındadır. İnce kesit BT kırık hattının yönünü, deplasmanı, kortikal kaybı ve lezyonun medüller/ekstraosseöz yayılımını üç düzlemde gösterir. Önceki inceleme ile karşılaştırma, kırık öncesi kemik lezyonunu belirginleştirir; kontrastsız kemik algoritması çoğu kırık değerlendirmesi için yeterlidir. Femur patolojik kırığında BT'de kırık ve korteks dışındaki yumuşak doku bileşeni değerlendirilebilir.

Faz ve pencere

Kontrastsız tanısal

İnce kesit kemik algoritmasında medüller litik/sklerotik lezyon içinden geçen kortikal kırık hattı, parçalanma, angulasyon ve yer değiştirme; korteksin kırık öncesi incelme/yıkımı aranır.

BT bulguları

• Lezyon içinden geçen kırık — ince radyolusent hat litik veya sklerotik medüller odağı keser; koronal/sagittal planda uzanımı şaft boyunca izlenir.
• Kortikal kesinti — kırık hattının bir veya iki korteksi bozduğu yer, çevresindeki tümör kaynaklı incelme ve destrüksiyondan ayrıştırılır.
• Parçalanma ve deplasman — kırık parçalarının translasyonu, angulasyonu, kısalması ve rotasyonel uyumsuzluğu kemik penceresinde tarif edilir.
• Medüller lezyon — kırık çevresinde litik, sklerotik veya mikst odak; endosteal oyulma ve lezyonun kemik çapına oranı gösterilir.
• Periostal yanıt — periostal reaksiyon kemik enfarktüsüyle ilişkili sarkomlarda ve femur osteomiyelitinde görülebilir; örüntüsü ve lezyonla ilişkisi değerlendirilir.
• Ekstraosseöz kitle — femur korteksini aşarak kemik dışına uzanan solid kitle, kemik tümörünün ekstraosseöz uzanımıyla ilişkili olabilir.
• Komşu bölge uzanımı — femur boynu kırığına eşlik eden ipsilateral şaft ve peritrokanterik bölge kemik lezyonları ayrıca değerlendirilir.
• Çoklu iskelet odağı — kapsanan pelvis/femur kesimlerinde başka medüller odakların varlığı patolojik zeminin yaygınlığını destekler.

Ölçütler ve sınıflamalar

Metastatik femur lezyonunda aksiyel kortikal tutulum ile artmış kırık riski

>30 mm

Mirels skoru: metastatik uzun kemik lezyonunda yüksek risk eşiği

≥9/12

Normalde

Brown tümör olgusunda proksimal femur korteksi kemiğin diğer bölümlerine göre yaklaşık üçte bir kalınlıktaydı ve kistik değişiklik gösteriyordu.

Ayırıcı tanı

Travmatik kırık

enerji ve travma mekanizmasıyla uyumlu hat görülebilir; önceden var olan fokal medüller lezyon veya kortikal oyulma patolojik zemini düşündürür.

Stres/insufficiency kırığı

kortekste ince radyolusent hat veya endosteal kalınlaşma görülebilir; primer malignite, destrüktif medüller kitle veya tümör kaynaklı ekstraosseöz komponent yokluğu tanısal olarak önemlidir.

Osteomiyelit

destrüksiyon, periostal yeni kemik ve yumuşak doku inflamasyonu yapabilir; sekestrum, kloaka veya apse kavitesi enfeksiyonu destekler.

Primer kemik sarkomu

kırıkla birlikte agresif permeatif kemik yıkımı, tümör matriksi ve yumuşak doku kitlesi gösterebilir; metastaz öyküsü olmayan hastada değerlendirilmelidir.

Metastatik kemik lezyonunda BT'de kırık varlığı ve kortikal bütünlük ayrı görüntüleme özellikleri olarak değerlendirilir.

Tuzaklar

• Tümör içi kırık hattını lezyonun kenarındaki endosteal oyukla karıştırma; kesintiyi ardışık ince kesitlerde ve iki ortogonal planda doğrula.
• Kırık çevresindeki hematomu otomatik olarak ekstraosseöz tümör kitlesi sayma; solid nodüler komponent, kortikal geçiş ve varsa kontrast davranışını ayrı değerlendir.
• Düşük enerjili düşme öyküsü patolojik nedeni dışlamaz; kırık hattının geçtiği kemikte önceden mevcut litik/sklerotik odağı ve önceki görüntüleri araştır.
• Mirels veya aksiyel kortikal tutulum ölçüsünü oluşmuş kırığın sınıflaması gibi sunma; bunlar metastatik odakta kırık risk tahminine yöneliktir.

Kendini dene

1. Düşük enerjili düşme sonrası femur şaftında kırık; hattın çevresinde litik medüller odak ve kortikal oyulma izleniyor. Bu kırık nasıl adlandırılır?

   • Patolojik kırık
   • Stres kırığı
   • Avulsiyon kırığı
   • Subkondral kırık
   Cevabı göster

   Patolojik kırık. Kırığın önceden zayıflamış litik kemik odağından geçmesi patolojik kırığı destekler. Stres ve subkondral kırıkta belirgin destrüktif tümör odağı beklenmez; avulsiyon kırığı tendon/ligament yapışma yerinde küçük kemik fragmanıdır.

2. Metastatik femur lezyonunda aksiyel kortikal tutulum 36 mm ölçülüyor. Bu bulgu neyi düşündürür?

   • Kırık riski artmıştır
   • Patolojik kırık oluşmuştur
   • Lezyon benign kabul edilir
   • Mirels skoru 9'dur
   Cevabı göster

   Kırık riski artmıştır. Aksiyel kortikal tutulumun ≥30 mm olması femoral metastazlarda yüksek kırık riskiyle ilişkilidir. Aksiyel kortikal tutulum ölçümü kırık riskini değerlendirmeye yardımcıdır; Mirels skorunu tek başına vermez, çünkü skor ağrı, yerleşim, lezyon tipi ve boyutuna dayanır.

İlgili konular

• Femur metastazı
• Femur fibröz displazisi
• Proksimal femur osteomiyeliti ve Brodie apsesi

Kaynaklar

Bu sayfadaki 38 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 6 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.