成人股骨头缺血坏死CT与病理对照研究  

Comparative Study on CT and Pathology in Femoral Head Necrosis of Adult

作　　者：刘吉华[1] 关悦 高振华[3] 李玉军[4] 

机构地区：[1]青岛大学医学院附属医院放射科,山东青岛266003 [2]青岛市骨伤医院放射科 [3]中山大学第一医院放射科 [4]青岛大学医学院附属医院病理科

出　　处：《实用放射学杂志》2006年第8期973-975,987,共4页Journal of Practical Radiology

摘　　要：目的通过成人股骨头缺血坏死(FHN)的CT与病理学对照研究,印证影像学表现的病理学基础。方法将8例成人髋关节置换下的完整坏死股骨头标本行CT扫描,根据CT扫描线将标本锯成相应厚度的片层,并摄X线片。再根据CT表现和标本片层X线表现与标本片层部位对应原则,在标本片层上多点取材,进行病理学观察。结果8例股骨头标本的CT表现、相应部位标本片层X线表现和片层肉眼及镜下改变有良好的对应关系。CT和片层X线平片上高密度硬化带肉眼观为暗黄色,内侧伴行的低密度透光带为棕褐色,硬化带和透光带包绕的病灶区及外侧区均呈淡黄色。光镜下,高密度硬化带区显示骨小梁粗大、新生骨和大量炎性纤维肉芽组织。透光带区显示大量炎性纤维肉芽组织,内可见成骨和死骨吸收碎片。硬化带包绕的淡黄色区主要为坏死的骨小梁和骨髓。硬化带外侧淡黄色区为正常骨和骨髓结构,可伴有少量炎性纤维肉芽组织和成骨。结论CT图像上硬化带为成骨区,内侧伴行的透亮带为大量炎性肉芽组织所在的修复区,硬化带包绕区为修复不明显的坏死区,外围区为正常骨所在区。在一定程度上反映了坏死后的修复过程。Objective To study the pathological basis of CT signs of femoral head necrosis （FHN） in adult. Methods 8 femoral head samples of FHN in adult were examined with CT scanner and were sawed into slices corresponding with CT figures , then the conventional radiographic slices were also offered. According to X - ray signs of the slices and corresponding CT figures of the femoral head samples, a lot of pieces（0.5 cm × 0.5 cm× 0.5 cm ） from the slices were obtained and were observed under microscope. Results In all the cases, color changes of cross section of the slices were corresponded with X - ray signs of the slices and CT signs of the femoral head . High density sclerosis band on CT and radiography was dark yellow, while low density band accompanied with high density sclerosis band look a little brown,the areas inside and outside low density band and high density sclerosis band were light yellow. Under microscope, thicken trabecula and bone formation were showed with inflammatory granulation tissue between trabeeula in high density sclerosis band . A great quantity of inflammatory granulation tissue were displayed in low density band, sometimes with bone formation and pieces of absorbed necrotic trabecula. Necrotic trabecula and necrotic bone marrow appeared in the area surrounded by low density band. Normal structure were manifested, some with a little ossification and granulation tissue , outside high density sclerosis band . Conclusion High density sclerosis band on CT is ossification area. Low density band is repairing area full of a great quantity of inflammatory granulation tissue, with absorbed trabecula. The area surrounded by low density sclerosis band was necrotic one nearly without repair. The area outside high density sclerosis band manifestes almost normaly. These somewhat reflect repairing process after necrosis.

关 键 词：股骨头缺血坏死 成人 体层摄影术 X线计算机 病理学 对照研究 

分 类 号：R681.8[医药卫生—骨科学] R814.42[医药卫生—外科学]