髋关节撞击综合征的MSCT影像学研究

Multi-slice CT in the femoroacetabulur impingement syndrome

目的探讨多层螺旋CT(MSCT)平扫、图像后处理重建技术和测量α角诊断髋关节撞击综合征(FAI)的价值。方法选取2013年3月至2017年5月洪泽区人民医院行MSCT扫描,临床诊断为FAI的32例患者的影像和临床资料,回顾性分析髋关节解剖学、骨质异常情况和α角测量的意义。结果所有患者中凸轮型8例、钳夹型9例、混合型15例;MSCT在显示FAI骨质细节中具有独特优势,特别是利用多平面重建(MPR)技术进行冠状面、矢状面、任意层面斜矢状位图像能够清晰显示FAI解剖学、细微骨质异常,其中呈典型"手抢柄"征5例,股骨颈疝窝7例,钳型9例,主要以髋臼异常表现为主,其中深髋臼2例,髋臼后倾3例,髋臼前方或后方过度覆盖4例;15例混合型FAI影像表现兼有凸轮型、钳型两者表现;本组所有FAI患者中,α角普遍增大,以凸轮型最大,范围55°~76°。结论多排螺旋CT平扫和图像后处理技术清晰显示股骨头及髋臼解剖及骨质异常,结合α角等参数测量分析,能够准确诊断FAI,对临床治疗方案的选择具有重要价值。

Objective To explore the value of multi-slice CT（MSCT）, imaging reconstruction and measurement of α angle in diagnosing femoroacetabulur impingement syndrome（FAI）. Methods The imaging and clinical data of 32 patients diagnosed as FAI who underwent MSCT from March 2013 to May 2017 in Hongze People＇s Hospital were collected. The anatomy of hip, abnormal bone structure, and measurement of α angle were analyzed respectively.Results Among the 32 patients, there were 8 cases of Cam type, 9 cases of Pincer type, and 15 of mixed type. MSCT is advantageous in displaying bone structure of FAI, especially with using multi-planner reformation（MPR） for anatomical structure of FAI and subtle bone abnormality（on coronal plane, sagittal plane oblique sagittal plane）. There were 5 cases of typical pistol-grip signs, 7 cases of herniation pits, and 9 cases of Pincer type. The main manifestation is acetabular abnormality, including 2 cases of deep acetabulum, 3 cases of acetabular retroversion, and 4 cases of anterior or posterior overcoverage of acetabulum. The 15 cases of mixed type FAI had manifestations of both Cam type and Pincer type. Increase of α angle was found in all the FAI patients, especially in Cam type, ranged from 55° to 76°. Conclusion MSCT and imaging reconstruction can well display the anatomy of femoral head and acetabulum, as well as bone abnormality,which, combined with measurement of α angle, can diagnose FAI accurately and has important value for selection of therapeutic regimen.