SARS康复患者骨坏死改变的MRI筛查

MRI screening on bone ischemia of hip and knee in recovered SARS patients

目的 探讨SARS康复患者骨缺血坏死的患病率 ,及其与激素使用的关系。方法 对76例SARS康复患者进行双髋和双膝关节MR扫描。其中男 17例 ,女 5 9例。在治疗SARS时 8例未使用激素 ,其余 6 8例均使用了激素治疗 ,其中 30例有确切激素用量、疗程。对患者全身骨关节症状进行问卷调查。由高年资医生阅读MR图像 ,诊断有无骨缺血坏死改变。对骨缺血坏死患病率、激素用量和症状等参数进行统计学分析。结果 (1)SARS康复患者股骨头和股骨髁部位出现的骨缺血坏死及骨髓内骨梗死的MRI表现符合临床诊断骨缺血坏死者的MRI典型表现。 (2 ) 8例未用过激素的SARS康复患者无一例出现骨缺血坏死改变 ,而 6 8例使用激素患者中 2 5例出现骨缺血坏死改变 ,两组比较差异有显著性意义 (P <0 0 5 )。 2 5例中有 2 0例累及双侧髋或 (和 )膝关节。骨缺血坏死改变累及股骨头 32个 ,股骨髁 2 6个 ,股骨、胫骨骨髓坏死 6处。在 30例有确切激素用量患者中 ,有骨缺血坏死表现的患者 13例 ,其使用激素总量的中位数为 35 70mg、每日最大用量的中位数为 2 5 0mg、激素使用时间的中位为数 2 3d ,均大于无骨缺血坏死组 (17例 ) ,相应中位数分别为 2 5 6 0mg、2 4 0mg和 2 2d。两组之间 3个参数经秩和检验差异无显著性意义 (P值均 >0 0 5 )

Objective To screen ischemia in the hip and knee joints of recovered SARS patients with MRI, and to investigate the prevalence rate of bone ischemia in those patients and its relationship with the use of steroid.Methods Hip and knee MRI examinations were performed in 76 recovered SARS patients.There were 17 males and 59 females.Eight patients were treated without steroid, while 68 patients with steroid.Dose and duration of steroid usage were available in 30 out of 68 patients.The MRI images were read by senior radiologists to determine whether bone ischemia and /or osteonecrosis was present.Appropriate statistic analysis was performed to determine the significance of difference between groups.Results (1) The MRI appearance of osteonecrosis in femoral head and condyle and bone infarct in bone marrow found in SARS patients was identical to those caused by other conditions (including steroid usage in other diseases).(2) No one of 8 SARS without steroid developed osteonecrosis, while 25 out of 68 steroid users had osteonecrosis found by MRI screening, and the difference in prevalence of osteonecrosis between these 2 groups was significant.In 25 patients with osteonecrosis, 20 of them involved more than one joints.Osteonecrosis involved 32 femoral heads, 26 femoral condyles, and 6 in femoral and tibial shafts.Thirteen patients with osteonecrosis had greater total steroid dose, greater daily dose, and longer duration than those (17 patients) without osteonecrosis, however, the differences between the two groups were not statistically significant.Sixity-four patients out of 76 complained pain in joints, 50 of them had multiple joint pains.The pain was reported in hips in 40 cases, followed by knees in 36, low backs in 10, shoulders in 7, and wrists in 4, respectively.The differences in frequency of pain between steroid users and non-steroid users, as well as between osteonecrosis and non-osteonecrosis were not significant.Conclusion MRI is recommended for screening the osteonecrosis in recovered SARS patients with steroid usage.MRI screening revealed high prevalence of osteonecrosis of hip and knee in SARS patients with steroid treatment.Most of SARS patients had multiple joint pains, and the cause for the pain was not clear.