股骨大粗隆结核的影像学表现

目的探讨股骨大粗隆结核的影像学表现。方法回顾性分析经临床、病理证实的28例股骨大粗隆结核的影像学资料。结果28例患者均是单侧股骨大粗隆受累，包括滑囊型4例，中心型3例，边缘型21例。X线表现：中心型主要表现粗隆部骨质密度增高，骨质破坏，粗隆或股骨颈增粗、变形，边缘型表现粗隆边缘骨质毛糙，骨质硬化、破坏，临近软组织肿胀，钙化等。CT表现：主要表现为粗隆区骨质破坏、溃烂，或脓腔及死骨形成，临近软组织肿胀或脓肿形成，及软组织内散在钙化。MRI表现：主要表现大粗隆区骨质破坏，呈稍长或长T1长T2信号，T_2W脂肪抑制像：明显高信号，软组织肿胀、渗出，或寒性脓肿形成，或伴有低信号钙化灶。结论股骨大粗隆结核的发病部位、临床及影像学表现具有一定特征性。X线平片和CT对骨质破坏、硬化及死骨和钙化灶观察有一定价值，对早期滑囊型病变诊断MRI检查更有价值。

Objective To investigate the imaging features of greater trochantetic tuberculosis. Methods Imaging features of 28 cases which were proved to be tuberculosis of greater trochanter by clinic and pathology were analyzed retrospectively. Results All of the cases were unilateral greater trochanter involvement （ 19 cases on the left, 9 cases on the tight ） , inculding bursae synovialis （ 4/28 cases ） , central （ 3/28 cases ） and peripheral （21/28 cases ） . All the patients were taken X-ray examination, showing 8 negative cases, 20 positive cases. The central type behaved as increased bone density, destruction, thicken and distortion in greater trochanter and neck of femur. The peripheral type represented coarse in the edge of greater trochanter, sclerosis, destruction, soft tissue swelling, and calcification. CT was performed in 18 patients, it mainly showed as destruction and fester in greater trochanter, formation of vomica and sequestrum, swelling and abscess of the soft tissues, sporadic calcification in the soft tissues. All of the 11 cases which performed MRI examination were positive, there were 4 cases that only soft tissue abnormalities are present. The destruction of greater trochanter displayed as hypointensity on TIWI, hyperintensity on T2WI, obvious hypetintensity on STIR. Abscess and ooze of the paravertebral tissues, psychrapostema, or complicated with hypointensity calcification were clear displayed on MP, I. Conclusion The site of occurrence, clinical and imaging features of greater trochantetic tuberculosis have some characteristics. X-ray and CT have certain value for the observation of destruction, sclerosis, sequestmm and calcification. However, it is more valuable for the diagnosis of MRI in early stage of bursae synovialis lesions.