股骨头缺血坏死早期的CT研究

CT study of early avascular necrosis of the femoral head

目的探讨股骨头缺血坏死(ANFH)早期CT表现并指导临床治疗。方法回顾性分析具有典型X线和CT表现并经临床病理或随访证实的49例成人ANFH的CT片,分析其CT早期征象并指导临床治疗。结果在49例的58个股骨头中20个股骨头骨小梁呈放射状密度增高的“星状征”,骨小梁境界清楚、锐利,属Ⅰ期;31个股骨头表现为骨硬化,骨小梁结构消失、模糊不清,骨密度减低及囊性改变,属Ⅱ期;并有7个股骨头在Ⅱ期影像改变基础上出现软骨下骨折及轻微塌陷,属Ⅲ期,X线和CT诊断的敏感性比较,得出x2=8.01,P<0.01,结果显示CT优于X线且差异有显著意义。结论CT可以诊断早期ANFH并能很好指导临床治疗。

Objective To study CT signs of early avascular necrosis of the femoral head (ANFH) and to guide the clinical treatment.Methods Forty-nine patients with clinically and pathologically proved ANFH underwent X-ray plain film and CT examinations of bilateral hip joints.The radiography findings and CT signs of early ANFH in all patients were analyzed retrospectively.Results Among 58 effected femoral heads of 49 cases,20 femoral heads presented trabecular increases density and radiate“stellate sign”with clear and sharp margin,which was classified as stage Ⅰ,31 femoral heads presented osteosclerosis,trabecular structure disappearing,hazy margin,decreased density,and cystic change,which was classified as stageⅡ,and 7 femoral heads presented subchondral fracture with slight collaps,which was classified as stage Ⅲ.The diagnostic sensitivity of CT for ANFH was greatly higher than that of X-ray plain film (X2=0.81,P< 0.01).Conclusion CT can make a definite diagnosis of early ANFH and therefore it can correctly guide the clinical treatment.