髋关节一过性骨髓水肿综合症的临床特征和MRI表现与鉴别分析

Clinical Features,MRI Findings and Differential Diagnosis of Transient Bone Marrow Edema Syndrvome of the Hip

目的分析髋关节一过性骨髓水肿综合症(TBMES)的临床特征及MRI表现。方法回顾性分析经磁共振成像(MRI)检查、随访证实的15例TBMES患者相关资料,观察TBMES临床特征及MRI表现。结果临床特征:所有患者患侧腹股沟区压痛,活动受限;实验室检查类风湿因子、血尿常规检查均正常;15例中单侧髋关节受累13例;累及股骨头、颈、股骨粗隆间12例;关节腔内积液7例。MRI对TBMES检出率明显高于X线片,差异有统计学意义(P<0.05)。股骨近端病变MRI上显示T1WI低信号,T2WI高或略高信号为主(12例),T2WI-STIR高信号;MRI显示关节腔内积液为长T1、长T2信号;MRI显示患侧髋关节周围肌肉层次清楚,无异常信号。随访6个月症状消失,MRI复查无复发。结论 TBMES典型特征为髋部疼痛,MRI诊断TBMES敏感度明显高于X线片,正确掌握TBMES主要征象有利于其诊断及鉴别。

Objective To analyze the clinical features and MRI findings of transient bone marrow edema syndrome of the hip （TBMES）.Methods Retrospective analysis was performed in 15 patients with TBMES confirmed by magnetic resonance imaging （MRI） and follow-up. The clinical features and MRI findings of TBMES were observed.Results In terms of clinical features, all patients suffering from tenderness in inguinal area and activity limitation. Laboratory examination found that rheumatoid factors, blood and urine routine were normal. Among 15 cases, there were 13 cases of unilateral hip involvement, 12 cases with involvement of femoral head, neck and femoral intertrochanteric area. 7 cases with articular cavity effusion. The detection rate of MRI in TBMES was higher than that of X-ray film （P〈0.05）. MRI of proximal femoral lesions showed low signal on T1WI, high or slightly high signal on T2WI （12 cases） and high signal on T2WI-STIR. MRI displayed that joint cavity effusion showed long T1 and long T2 signal. MRI showed that the muscle layers around the affected side of the hip joint were clear without abnormal signal. After 6 months of follow-up, the symptoms disappeared, and there was no recurrence found by MRI review.Conclusion The typical feature of TBMES is hip pain. The sensitivity of MRI in the diagnosis of TBMES is higher than that of X-ray. Correctly grasping the main features of TBMES is conducive to the diagnosis and identification.