髋关节色素沉着绒毛结节性滑膜炎X线特点分析

AN ANALYSIS ON X-RAY CHARACTERISTICS OF PIGMENTED VILLONODULAR SYNOVITIS OF THE HIP

为探讨髋关节色素沉着绒毛结节性滑膜炎的X线影像特点。回顾性分析了经手术及病理确诊的42例髋关节色素沉着绒毛结节性滑膜炎患者的X线表现,从髋关节间隙变化、股骨头及髋臼破坏、囊性改变、骨赘增生、软组织改变等方面进行观察。结果42例均存在不同程度髋关节间隙狭窄,其特点为关节间隙狭窄并不局限于负重区,而呈全关节间隙均匀性狭窄;22例可见关节骨端大小不等、数量不一的虫蚀样或锯齿样皮质破坏区。36例存在3处以上大小不等囊性改变,囊性改变分布范围广泛,股骨头、股骨颈及髋臼可同时累及,囊性变边缘有轻度硬化现象,股骨颈广泛破坏者尚可见多条嵴状硬化线;7例可见轻微骨赘增生;1例出现软组织密度增高影。所有病例均未见钙化现象。表明髋关节由于关节腔狭小,病变滑膜增生扩张范围受限,病变滑膜易导致严重的关节损害,并在X线上同时出现多项改变。认为髋关节X线检查对髋关节色素沉着绒毛结节性滑膜炎的初步筛检具有较高的应用价值。

In order to explore the X-ray characteristics of pigmented villonodular synovitis of the hip(PVS),the X-ray expressions of 42 cases of PVS confirmedly diagnosed through the surgery and pathology were retrospectively analyzed;the observed objects included: hip joint space change,damage of femoral head and acetabulum,cystic change,osteophyte proliferation,soft tissue change,etc.The results showed that all of 42 cases had hip joint space stenoses in varied degrees,which were characterized by the even stenosis not limited in the loaded part but spread in the whole joint;22 cases had cortex damage in the joint epiphysis,which was moth-eaten,serrated,variedly sized and numbered;36 cases had three or more differently-sized and widely-spread cystic changes,which involved the femoral head and neck and acetabulum with slight sclerosis in the edge but many ridge sclerotic lines could be seen in expansive femoral neck damage;7 cases had slight osteophyte proliferation;one case had increased-density image;no calcification was seen in all the cases,suggesting that since the proliferation and expansion of the diseased synovium in PVS is limited due to the hip cavity stenosis and the diseased synovium tends to cause the severe joint injury and many X-ray changes,the X-ray examination is believed to have a high application value for the differential diagnosis of PVS.【