严重急性呼吸综合征康复患者骨缺血性坏死患病率的MRI筛查研究  

The prevalence of osteonecrosis in severe acute respiratory syndrome patients: an MRI screening study

作　　者：程晓光[1] 屈辉[1] 刘薇[1] 刘霞[1] 程克斌[1] 赵涛[1] 李晓松[1] 梁伟[1] 郭俊[1] 

机构地区：[1]北京积水潭医院放射科,100035

出　　处：《中华放射学杂志》2005年第8期791-797,共7页Chinese Journal of Radiology

基　　金：北京市卫生局SARS专项科研基金资助项目

摘　　要：目的采用MRI对康复的严重急性呼吸综合征(SARS)患者骨缺血性坏死进行筛查,探讨康复SARS患者骨缺血性坏死的患病率,及与激素使用的关系。方法用MRI对448例感染SARS的康复患者进行骨缺血性坏死筛查。所有受试者都做了双髋和双膝关节MR扫描,其中192例还扫描了肩和踝关节。采用体线圈同时扫描双侧关节,扫描序列常规做冠状面T1WI,如发现有骨缺血性坏死征象,加扫短时反转恢复(STIR)序列。178例在MR检查的同一天还行双髋关节正位和蛙式位数字X线摄影(DR)片。所有MR图像由3位高年资医生阅片,诊断有无骨缺血性坏死。由2位医生在不知道MRI结果的情况下阅读双髋关节正位和蛙式位DR片,判断有无骨缺血性坏死。448例中在“SARS临床研究数据库”有用药记载者386例,其中361人在治疗过程中使用激素并记载了剂量和时间;“SARS临床研究数据库”无用药记载的其余62例中有59例自述治疗时使用激素。结果骨缺血性坏死的MRI表现为关节面下骨髓内出现弧形或线形异常信号带,T1WI为低信号,在STIR序列上为高信号,与临床上所见的因其他疾病而使用激素或饮酒等原因引起的骨缺血性坏死表现相同。MRI筛查发现在448例中共有138例(30.8%)出现1处以上骨缺血性坏死。28例未用激素的患者中有1例出现有股骨干骨梗死征象(1/28),420例使用激素患者的MRI筛查发现137例(32.6%)出现至少1处骨缺血性坏死MRI表现,两组间差异有统计学意义(P<0.05)。股骨头缺血性坏死101例,均有使用激素史,占激素使用者的24.0%(101/420)。膝关节骨缺血性坏死84例,占激素使用者的20.0%(84/420)。同时累及股骨头和膝关节者48例,占激素使用者的11.4%(48/420),仅发生在股骨头者53例,占激素使用者的12.6%(53/420),而仅发生于膝关节者36例,占激素使用者的8.6%(36/420)。192例双侧肩关节和踝关节MR扫描发现肱骨头缺血性坏死26例(13.5%),踝Objective To screen for osteonecrosis in major joints in severe acute respiratory syndrome （ SARS ） patients with MRI, to determine the prevalence of osteonecrosis in the population and explore the association between the administration of corticorsteroids and the occurrence of osteonecrosis.Methods All 448 medical professionals infected with SARS in Beijing area were recruited to undergo MRI screening for osteonecrosis of their major joints. The joints surveyed included both hips, both knees in all 448 patients, additionally both shoulders and both ankles were scanned in 192 patients. In order to save time, body coils were used to cover both sides of the joint, routine T1 weighted coronal images of both sides of the joints were acquired, if abnormalities werefound, STIR coronal images were added. Direct radiographs （DR） of both hips were obtained in 178 patients in the same day with MRI. All MR images were interpreted by 3 senior radiologists with regarding to the presence of osteonecrosis. X-rays were evaluated by 2 radiologists to determine if osteonecrosis was present without knowing the results of MRI. Three hundred and eighty-six patients had records in the “SARS clinical research database” which was retrieved from the medical records, and 361 of them had records of the adminstration of corticorstereids, duration,accumulative dose and average daily dose. Fifty-nine out of the remaining 62 patients without records in the database reported corticorsteroids usage by themselves in the questionnaires. All statistical analysis was performed with SPSS 10. 0. Results The MRI appearance of osteonecrosis seen in SARS patients was identical to those caused by other conditions seen in clinical practice, the typical findings were linear or rimlike abnormal signals in the bone marrow of subchondral area, low signal in T1 WI and high in STIR images.One hundred and thirty-eight patients （30. 8% ） were found to have osteonecrosis in at least one location in the whole population （448 patients ）. One out o

关 键 词：严重急性呼吸综合征 疾病康复 骨缺血性坏死 患病率 MRI检查 激素治疗 

分 类 号：R511.9[医药卫生—内科学]