骨缺血坏死动态变化的MRI研究

A retrospective study on dynamic changes of ischemic femoral head necrosis with MRI

目的评价磁共振成像技术在成人股骨头缺血坏死诊断中的作用,分析单侧髋关节症状就诊患者股骨头坏死的MRI表现,从而了解骨缺血坏死的动态变化。方法搜集2001~2014年间,病理证实的成人股骨头坏死患者70例,41例患者因单侧髋关节疼痛不适就诊（15例患者左髋疼痛,26例患者右髋疼痛）,29例患者因双侧髋关节疼痛不适就诊。均行双侧髋关节MRI检查。结果单侧髋关节疼痛不适就诊41例患者中,25例患者在MRI上出现双侧股骨头异常,16例患者仅在症状侧股骨头出现异常。单侧股骨头受累组与双侧股骨头受累组两组间病变分期差异有显著性意义（χ^2=6.233,P=0.013）,但两组间患者的发病时间差异无显著性（t=1.794,P=0.080）。41例患者中,19例患者可见股骨头及股骨颈同时受累,22例仅有股骨头受累。股骨颈病变表现为骨髓水肿,股骨头表现主要为＂双线征＂。股骨头受累组和股骨头并股骨颈受累组两组间病变分期差异有显著性（χ^2=7.587,P=0.006）,但两组间患者的发病时间差异无显著性（t=2.009,P=0.053）。股骨颈受累在双侧股骨头受累的患者更常见（χ^2=5.299,P=0.021）。结论股骨头缺血坏死病例可先累及单侧股骨头,后累及对侧股骨头。股骨头坏死早期可能没有症状。骨髓水肿是病情进展的潜在信号。无症状髋关节的检查对于临床工作有重要意义。

Objective To study the role of MRI on diagnosis of ischemic femoral head necrosis and to evaluate the development of femoral head necrosis by MRI. Methods Seventy patients with pathologically confirmed osteonecrosis of femoral head were consecutively examined with MRI. Among these 70 patients,41 patients complained unilateral pain in hip joint,while 29 patients complained bilateral pain in hip joints at both sides. Results Among 41 patients,25 patients were diagnosed as bilateral abnormality in femoral heads,16 patients were diagnosed as lateral femoral head involved. There was significant difference in pathologic stage of osteonecrosis of femoral head between patients with both femoral heads involved and patients with unilateral femoral head involved（χ^2 = 6. 233,P = 0. 013）,while there was no significant difference in duration of symptoms in hip joints between these two groups（ t = 1. 794 P = 0. 080）. 19 patients were diagnosed as simultaneously involved femoral neck and femoral head where it appeared as bone marrow edema in the femoral neck,22 patients were diagnosed with femoral head involved,where it ap-peared dominantly as ＂double line sign＂. There was significant difference in pathologic stages of osteonecrosis in femoral head between patients with both femoral head and femoral neck simultaneously involved and patients with femoral head involved（χ^2 = 7. 587,P = 0. 006）,while there was no significant difference in duration of symptoms of hip joints between these two groups（ t = 2. 009,P = 0. 053）. Bone marrow edema was more prevalent in patients with bilateral femoral heads involved than that of unilateral femoral head involved（χ^2 = 5. 299,P = 0. 021）. Conclu-sion MRI plays a dramatic role in comprehensive development of ischemic necrosis of femoral head. Bone marrow edema should be considered as a marker for potential progression to advanced osteonecrosis. It is important to examine hip joint of persons with high risk even it is nonsymptomat-ic.