MRI观察SARS患者激素治疗后骨缺血性坏死改变

MRI investigation on steroid induced osteo-ischemia of SARS

目的 使用MRI观察SARS患者激素治疗后骨缺血性改变。方法 采用MRI对 2 3例SARS患者激素治疗后的髋关节、下肢、肩、腰椎等部位进行 38次扫描 ,其中 7例病人加做X线平片检查。结果 MRI显示 :(1)骨缺血坏死 31个部位 ,其中股骨头 2 8个 (Ⅰ期 16个 ,Ⅱ期 8个 ,Ⅲ期 4个 ) ;右胫骨平台下坏死 1个 ;左右肱骨头各 1个关节面下小斑片状坏死。 (2 )骨梗死 ,1例重型SARS患者 (双侧股骨头坏死Ⅲ期、左肱骨头坏死 )出现多处骨梗死 (双侧股骨、双侧胫骨、双侧跟骨、双侧距骨 )。 (3)骨髓水肿 4 8个部位 ,其中 4 3个髋关节 ,3个胫骨平台下和 2个肱骨头下骨干。 (4)髋关节腔积液 16个 ,9个膝关节内发现轻度积液。X线平片无阳性发现。结论 SARS患者在长时间大剂量使用激素治疗后 ,股骨头及其他部位骨骼发生缺血性病变比率高。骨骼病变的转归尚需做进一步的深入研究。

Objective To investigate the steroid induced osteo-ischemia of recovered SARS with MRI. Methods 38 studies of MRI were performed on hips,lower limbs,shoulders,and lumbar vertebrae in 23 SARS patients treated with steroid.Hip X-ray was conducted in 7 of the 23 cases. Results MRI:(1) Avascular osteonecrosis was found in 31 places,including 28 femoral heads (stage Ⅰ 16,stage Ⅱ 8,stage Ⅲ 4 ),1 tibial plateau,and 2 humerus capita; (2) Osteo-infarction was detected in multiple sites (bilateral femora,tibiae,calcaneus,and tali) in a severe case (also had osteonecrosis of bilateral femoral heads and left humerus capita).(3) Bone marrow edema was seen in 48 places,including 43 hips,3 tibial plateaus,and 2 humerus capita.(4) Joint fluid was found in 16 hips and 9 knees.No positive finding was detected in X-ray.Conclusion The steroid induced osteo-ischemia is frequent in SARS.The image follow-up is needed.