股骨上端骨髓水肿综合征10例临床及影像学分析

Clinical and imaging analysis of proximal femur bone marrow edema syndrome in 10 cases

背景:股骨上端骨髓水肿综合征为自限性疾病,具体的发病机制尚未完全明确,因此目前临床上没有明确的治疗措施,主要以对症处理为主,不遗留严重后遗症。目的:分析股骨上端骨髓水肿综合征的病因、临床表现、影像学特点及其与股骨头缺血性坏死的关系和区别。方法:收集2007-09/2010-05在苏州大学附属第一医院门诊以股骨头缺血性坏死首诊,后确诊为股骨上端骨髓水肿综合征患者,共10例11髋(男5例,女5例)为研究对象,均采取门诊治疗,急性期减少患肢活动量,避免患肢过度负重,有长期饮酒史患者,劝其戒酒,疼痛较重患者口服非类固醇抗炎止痛药物等治疗,原有基础疾病继行相关治疗,定期门诊随访,影像学复查。结果与结论:全部病例经治疗后临床症状明显改善,未有不良后遗症。X射线平片示股骨头形状完整,关节面无塌陷,治疗前MRI图像显示的T1像加权低信号,T2加权或STIR成像上高信号的现象于治疗后消失,其预后与股骨头缺血性坏死有明显区别。提示股骨上端骨髓水肿综合征是一种致病原因复杂的自限性疾病,应了解其临床特征,明确诊断,避免误诊,选择正确的治疗方案。

BACKGROUND：Femur bone marrow edema syndrome is a self-limiting disease,and its specific mechanism is yet unclear.There is currently no clear clinical treatment,and the treatment for femur bone marrow edema syndrome is mainly based on symptomatic treatment,and no serious complications.OBJECTIVE：To analyze the etiology,clinical manifestations,imaging features of proximal femur bone marrow edema syndrome as well as its relationship and difference with avascular necrosis of the femoral head.METHODS：From September 2007 to May 2010,11 hips of 10 cases（5 males and 5 females） were collected in the out-patient,the First Affiliated Hospital of Soochow University.The first diagnosis of the 10 cases was avascular necrosis of the femoral head,and then diagnosed as proximal femur bone marrow edema syndrome.The clinical manifestations and imaging data before and after treatment were detected.RESULTS AND CONCLUSION：The clinical symptoms of all patients were all improved,and no adverse consequences remained.From the X-ray films,the shapes of all femoral heads were intact,non-articular surface collapsed.The original low signals in T1-weighted images and high signals in T2-weighted images or short TI inversion recovery images all disappeared,the prognosis of proximal femur bone marrow edema syndrome was evident from avascular necrosis of the femoral head.These indicate that the proximal femur bone marrow edema syndrome is a self-limiting disease with complex causes,and it is very important to be aware of the clinical characteristics,in order to clarify diagnosis,avoid misdiagnosis,and choose appropriate treatment.