广州市传染性非典型肺炎康复者骨坏死MRI普查初步报告

Report on the investigation of lower extremity osteonecrosis with magnetic resonance imaging in recovered severe acute respiratory syndrome in Guangzhou

目的 报告广州市四家医院 12 4例严重急性呼吸综合征 (SARS)康复医务人员下肢骨缺血相关病变的发病情况 ,并初步分析其与皮质类固醇激素使用的相关性。方法 对来自广州市 4所医院的 12 4例SARS康复医务人员下肢骨包括双侧髋关节及膝关节进行MRI检查。 12 4例中 38例未使用激素治疗 ,86例使用不同剂量的激素治疗。MRI检查分为筛查与详查。筛查包括T1加权成像及短TI反转回复序列冠状位成像。筛查有阳性发现者则进行详查 ,详查为在筛查的基础上加用横断位、冠状位T2加权成像及短TI反转回复序列成像。结果 86例使用激素治疗的SARS康复者中 ,共发现 3例骨缺血坏死 ,其中 1例为双侧股骨头缺血坏死 ,1例为单侧股骨头缺血坏死 ,另 1例为双侧股骨头、胫骨髁及单侧股骨髁缺血坏死。另发现 1例双侧股骨胫骨骨髓水肿 ,1例单侧股骨颈骨梗死并已钙化。未使用激素的 38例均未发现骨缺血性改变。Logistic回归分析显示激素单日最大剂量与骨缺血性改变有相关性。结论 广州市使用激素治疗的SARS康复医务人员中 ,少数发生骨缺血坏死 ,激素单日最大剂量与骨缺血性病变关系密切。

Objective To report the occurrence of lower extremity avascular abnormalities in 124 cases of recovered severe acute respiratory syndrome (SARS) health care workers of four hospitals in Guangzhou and preliminary investigate the correlation with the treatment of steroid. Methods 124 health care workers with recovered SARS from four hospitals in Guangzhou were examined with MR imaging of the lower extremity including bilateral hips and knees. In 124 health care workers, 38 cases have not treated with steroid, while 86 cases have treated with varied dosage. The imaging protocol was consisted of screening and full examination. Coronal T1 weighted imaging and short tau inversion recovery sequence were defined as the screening examination. The full examination was defined as images from the screening examination plus three additional imaging sequences: transverse and coronal T2 weighted imaging and short tau inversion recovery sequence. Results In 86 health care workers, 5 cases were found positive in the lower extremity. Osteonecrosis was found in 3 cases. One was involved in bilateral femoral head, and another was unilateral femoral head, and the remaining one was bilateral femoral heads and unilateral femoral condyle and tibial condyle. Bilateral femoral and tibial marrow edema were found in one case. Femoral infarction with significant calcification occurred in one health care worker. Logistic regression analysis indicated that the presence of avascular abnormalities was related with maximum daily dosage. Conclusion Osteonecrosis definitely exists in the minority of health care workers with recovered SARS in Guangzhou, who had treated with steroid. The maximum daily dosage of steroid may significantly influence on the occurrence of avascular abnormalities.