严重急性呼吸综合征患者激素治疗康复后膝关节骨坏死的MRI监测  

Magnetic resonance imaging monitoring for osteonecrosis of the knee joints in recovered patients with severe acute respiratory syndrome after administration of glucocorticoids

作　　者：程克斌[1] 程晓光[1] 屈辉[1] 刘薇[1] 赵涛[1] 孙晶[1] 

机构地区：[1]北京积水潭医院放射科,100035

出　　处：《中华全科医师杂志》2006年第4期223-226,T0002,共5页Chinese Journal of General Practitioners

摘　　要：目的评价用MRI监测经糖皮质激素治疗的严重急性呼吸综合征(SARS)患者康复后膝关节骨坏死的出现率和MRI特点。方法对99例(男22例,女77例)经糖皮质激素治疗SARS康复患者的198个膝关节进行MR检查,判断有无膝关节骨缺血坏死。结果99例中有31例患者出现骨坏死(占31%),其中双膝多发病灶为25例,单膝发病6例;在双膝多发病例中病灶均呈对称性分布,共出现166处病灶,占发病膝关节分区的27%166/(56×11)。病灶累及负重区与非负重区的比例为27∶29;病灶位于关节软骨下为84%(47/56)。166处病灶累及区域:股骨内侧髁后部27处(16%),内侧髁前部14处(8%),外侧髁后部44处(27%),外侧髁前部29处(17%),干骺端18处(11%);胫骨平台内侧髁前部3处(2%),内侧髁后部13处(8%),外侧髁前部2处(1%),外侧髁后部7处(4%),干骺端9处(5%);髌骨0处。结论MRI能很好地显示膝关节的骨缺血坏死改变。在使用糖皮质激素治疗的患者中,应尽早行MR检查,以便早期诊断和早期治疗。Objective To evaluate the magnetic resonance imaging （MRI） monitoring for osteonecrosis of the knee joints in recovered patients with severe acute respiratory syndrome （SARS） after the administration of glucocorticoids and its characteristics. Methods One hundred and ninety-eight knee joints in 99 recovered SARS patients after administration of glucocorticoids, 22 males and 77 females, were examined by MRI and interpreted independently by four senior radiologists for determining osteonecosis. Results Osteonecrosis were found in 56 knee joints （28% ,56/198） in 31 of 99 patients （31% ,31/99）, 25 with bilateral lesions （81% ,25/31 ） and six unilateral ones （19% ,6/31 ）. The lesions were symmetric （ 100% , 25/25 ） in all the patients with bilateral osteonecosis, involving weight-bearing zone in 27, non- weight-bearing zone in 29 and subchondral zone in 47 knee joints （84% ,47/56）. The anterior zone of the medial femoral condyle was involved in 14 （8%） lesions, the posterior zone of the medial femoral condyle in 27 （ 16% ） ,the anterior zone of the lateral femoral condyle in 29 （ 17% ） ,the posterior of the lateral condyle in 44 （27%） ,the metaphysis of femur in 18 （ 11% ） ,the anterior zone of the medial tibial plateau in three （2%）, the posterior zone of the medial tibial plateaus in 13 （8%）, the anterior zone of the lateral tibial plateaus in two （ 1% ）, the posterior zone of the lateral tibial plateau in seven （ 4% ）, the metaphsis of the tibia in nine （5%） ,and no lesion was found in the patella. Conclusions MRI can preferably be used to reveal changes of ischemia and necrosis in the knee joints. So, MRI for the knee joints should be earlier performed in the patients with glucocorticoids for diagnosis and therapy for them.

关 键 词：急性呼吸综合征 糖皮质激素类 骨坏死 膝关节 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学]