快速破坏性髋关节病的临床特点及影像学征象分析

Analysis of Clinical Features and Imaging Signs of Rapidly Destructive Hip Disease

目的探讨快速破坏性髋关节病(RDHD)的临床及影像学特征,提高对该病的认识,降低误诊率和漏诊率。方法回顾性分析2016.12月至2023.05月经临床确诊为RDHD的患者13例,分析其临床及影像学资料,并复习相关文献。结果13例RDHD患者,男5例,女8例,其中10例病人有3次的影像学检查,首次检查表现为髋关节间隙正常或轻度变窄,股骨头外形及轮廓光整8例,MRI显示股骨近端及髋臼的骨髓水肿5例,其中2例出现股骨头软骨下不全骨折;第2次检查X线表现为关节间隙明显变窄8例,CT显示股骨头软骨下骨质吸收溶解,关节间隙变窄4例;MRI显示关节间隙变窄,股骨头软骨下骨质吸收,滑膜增厚及关节腔积液5例;第3次影像学表现为股骨头骨质大部分吸收破坏,8例合并髋臼骨质破坏。3例患者进行了2次影像学检查,股骨头及髋臼骨质破坏进展迅速,最后股骨头及髋臼大部分骨质溶解吸收,髋关节半脱位。结论RDHD早期影像学表现为关节间隙轻度变窄,股骨头关节面光整,中晚期股骨头、股骨颈及髋臼进行性骨质吸收破坏。

Objective To investigate the clinical and imaging characteristics of rapidly destructive hip disease(RDHD),improve the understanding of RDHD,and reduce the rate of misdiagnosis and missed diagnosis.Methods 13 patients with clinically diagnosed RDHD during menstruation from December 2016 to May 2023 were retrospectively analyzed,their clinical and imaging data were analyzed,and related literature was reviewed.Results Among the 13 patients with RDHD,5 were males and 8 were females.Among them,10 patients had 3 times of imaging examination.The first examination showed normal or mild narrowing of the hip space,and the appearance and contour of the femoral head were smooth in 8 cases.MRI showed bone marrow edema of proximal femur and acetabulum in 5 cases,and subchondral incomplete fracture of femoral head in 2 cases.The X-ray findings of the second examination showed obvious narrowing of the joint space in 8 cases;CT showed subchondral bone dissolution of the femoral head,and the joint space was narrowed in 4 cases.MRI showed obvious narrowing of joint space,subchondral bone absorption of femoral head,obvious thickening of synovial membrane and fluid accumulation of joint cavity in 5 cases.The third imaging findings showed axe-like abnormal changes in the absorption destruction of most of the bone of the femoral head,which could involve the femoral neck,and bone destruction of the acetabulum in 8 patients.Three patients underwent 2 radiographic examinations.The bone destruction of the femoral head and acetabulum progressed rapidly,and finally most of the bone dissolution and absorption of the femoral head and acetabulum resulted in hip sublxation.Conclusion In the early stage of RDHD,most of the imaging manifestations were mild narrowing of joint space,smooth articular surface of femoral head,progressive bone resorption destruction of femoral head,femoral neck and acetabulum.