骨关节结核的CT诊断(附33例报告)

CT diagnosis of tuberculosis of bone and joint(report of 33 cases)

目的 :探讨CT对骨关节结核的诊断价值。方法 :收集经临床和手术病理证实的骨关节结核 (脊柱结核 2 4例 ,骶髂关节结核 5例 ,髋关节结核 4例 ,耻骨联合结核 1例 ) ,对其CT表现作回顾性分析。结果 :2 4例脊柱结核均有不同程度的骨质破坏 ,2 2个椎体可见溶骨性骨质破坏 ,15个椎体边缘见到虫蚀状骨质缺损 ,病变严重者可见椎体膨胀、碎裂或塌陷。多数病例伴有死骨、椎旁脓肿或腰大肌脓肿。骶髂关节结核常见单侧发病 ,关节面模糊、骨质破坏及死骨形成 ;关节间隙增宽 ,常伴冷脓肿和窦道形成。髋关节结核表现为骨性关节面、髋臼及股骨头侵蚀破坏 ,髋臼变浅或变平 ,导致关节脱位。结论 :CT能较好地显示骨质破坏的程度和范围以及死骨、冷脓肿等结核特征性的表现 ,是诊断骨关节结核的重要影像学手段。

Objective:To evaluate CT diagnostive value in the tuberculosis of bone and joint.Methods:Thirty-three cases of clinically or pathologically-proved tuberculosis which include spine(n=24),sacro-iliac joint(n=5),hip joint (n=4) and symphysis pubis (n=1) werw collected.Results:The CT findings were as follow:all the spinal TB patients had vertibral body damags, 22 with osteolytic destruction in the body, 15 with erosion of the boder and with expansive changes or collaps of the vertibral body in severe cases.Sequestrum and paravertebral or psoas abscess was seen in most of the cases.Sacro-iliac joint TB often involved unilateral joint.The lesion usually manifested itself as blurred articular surface,bone destruction,sequestrum,widened joint space,cold abscess and sinus. TB of hip joint demonstrated irregullar destruction of articular surface and femal head. Acetabula damaged and became sallow, leading to dislocation of hip joint.Conclusion:CT can demonstrat characteristic features of tuberculosis like sequestrum and cold abscess,as well as the degree and extent of bony destruction and play an importent role in diagnosis of tubercolosis of bone and joint.