成人股骨头缺血坏死并软骨下骨折:平片、CT与MRI和病理结果的对照研究  

Subchondral fractures in adult femoral head necrosis:Comparison study of radiography,computer tomography,magnetic resonance imaging and pathological results

作　　者：刘春红[1] 杜铁桥[1] 董杰[1] 李海梅[1] 张宇[1] 

机构地区：[1]首都医科大学附属复兴医院MRI室,北京市100050

出　　处：《中国组织工程研究与临床康复》2010年第13期2353-2356,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：北京市优秀人才培养资助(20051D0900710)~~

摘　　要：背景:软骨下骨折是成人股骨头缺血坏死的重要合并症,对患者的治疗和预后有重要影响,然而有关软骨下骨折的病理及影像学表现尚缺乏深入的研究。目的:比较X射线平片、CT和MRI对诊断股骨头缺血坏死并软骨下骨折的敏感性。方法:选择临床确诊的股骨头缺血坏死患者82例(132髋),依次行X射线、CT和MRI检查,并对其中手术切除的16个股骨头标本进行切片、脱钙和苏木精-伊红染色,然后在显微镜下进行观察。结果与结论:132髋中,平片或CT确诊软骨下骨折72髋,X射线平片51髋,CT60髋,MRI33髋。与CT相比,MRI敏感性和特异性分别为36%和100%,平片敏感性和特异性分别为70%和96%。CT诊断股骨头缺血坏死并软骨下骨折优于MRI(χ2=10.95,P<0.05)。本组16个股骨头大体标本与影像学对照研究显示,软骨下骨折区可见液体积聚和纤维肉芽组织增生,对应于X射线和CT上软骨下裂隙状透亮影,与上述病理过程是一致的。结果说明CT显示股骨头缺血坏死并软骨下骨折优于平片或MRI;MRI有助于观察股骨头缺血坏死后软骨下骨折的伴随征象,尤其T2WI+脂肪抑制,可评价骨折处的液体。CT检查实属X射线的更精细断层扫描。BACKGROUND： Subchondral fractures were identified as the most complication of the femoral head necrosis and had important influences on the treatment and prognosis. The pathological and radiological findings on subchondral fractures of the femoral head necrosis have rare deep investigation. OBJECTIVE： To compare the sensitivity of X-ray plain film, CT and magnetic resonance imaging （MRI） in revealing subchondral fractures. METHODS： A total of 82 patients （132 hips） with known osteonecrosis were examined consecutively with MRI, CT and plain film. Sixteen resected specimens were sliced, decalcified, stained with hematoxylin and eosin, and examined using microscopy. RESULTS AND CONCLUSION： Of 132 hips, 72 of the 132 hips with subchondral fractures were proved by radiography or CT, and 51 were detected on plain film, 60 on CT and 33 on MR images. Compared with CT, MR imaging has sensitivity and specificity of 36% and 100%. Radiography has sensitivity and specificity of 70% and 96% respectively. CT revealed more subchondral fractures in femoral head necrosis than MR imaging （χ^2=10.95, P 〈 0.05）. All histological sections in subchondral fractures area showed fluid accumulation and fibroblastic proliferation, which were corresponded slit-shaped radiolucent shadow on subchondral fractures using X-ray and CT, and consistent with above-described pathological processes. Results indicated that CT revealed more subchondral fractures in femoral head necrosis than radiography or MRI. MRI provided useful signs accompanied by subchondral fractures, especially T2WI＋ fat-suppression, and evaluated liquid at fracture site. CT provided more detailed information than plain film.

关 键 词：股骨头坏死 软骨下骨折 应力改变 数字化骨科 数字化影像技术 

分 类 号：R394.2[医药卫生—医学遗传学]