成人股骨头坏死的早期MRI与X线片图像分析诊断  

Early Detection of Osteonecrosis of Femoral Head in Adult by MRI and Radiograph

作　　者：胥少汀[1] 李自立[1] 李增洲[1] 张立仁[1] 姜金卫[1] 梁毅[1] 

机构地区：[1]北京军区总医院骨科

出　　处：《中华骨科杂志》1999年第4期207-210,共4页Chinese Journal of Orthopaedics

摘　　要：目的评价早期股骨头缺血坏死（ａｖａｓｃｕｌａｒｎｅｃｒｏｓｉｓｏｆｆｅｍｏｒａｌｈｅａｄ，ＡＮＦＨ）ＭＲＩ检查的诊断价值，并与同期髋Ｘ线片进行图像分析对比。方法对疑有早期股骨头坏死者行ＭＲＩ检查，同时摄髋正位Ｘ线片，进行图像分析对照，包括（１）单侧髋已证实为ＡＮＦＨ，其对侧髋尚无临床症状４例；（２）２例有髋痛，双髋Ｘ线片正常；（３）２例股骨颈骨折已愈合１年，开始髋痛，Ｘ线片正常；（４）髋臼骨折与头骺滑脱后骨关节炎、髋痛各１例为对照，总计１０例１６髋。按Ｆｉｃａｔ分期：０期４髋，Ⅰ期５髋，Ⅱ期２髋，Ⅲ、Ⅳ期各１髋，无坏死３髋。结果ＭＲＩ检查：０～Ⅰ期９髋，Ⅱ期２髋。在矢状位改变有头内散在低信号４髋，头内低信号带２髋，头顶低信号包绕中或高信号３髋，头大部为低信号２髋，头外上低信号内中信号１髋。横断位改变有头内广泛不均匀低信号４髋，头前部低信号４髋，头前低信号包绕中高信号２髋，头内大部低信号２髋，头外侧低信号中包中信号１髋，头内“Ｘ”形低信号１髋。Ｘ线片０～Ⅰ期与非头坏死共１０髋行图像分析处理（伪彩、纹理、灰度），显示头顶区呈坏死影像者６髋，占６０％。０～Ⅰ期６髋经病理证实。结论临床有下述情况者，应行ＭＲＩ检查：?ObjectiveTo evaluate the diagnostic value of MRI in early stage of avascular necrosis of femoral head(ANFH) and compare the findings with that in the radiograph. MethodsSixteen hips in 10 patients were studied with MRI and routine radiographic examination. According to Ficat classification,there were 4 hips in stage 0, 5 in stage I, 2 in stage and one each in stage and . In the remaining 3 hips,there was no evidence of necrosis. ResultsThe sagittal plane imaging can be divided into five patterns. Multiple spotted areas of low signal intensity in the femoral head was seen in 4 hips(type I); bandlike areas of low signal intensity was seen in 2 hips(type ); low signal intensity rim around the intermediate signal area in top of the head was seen in 3 hips(type ); low signal intensity was diffusely spread in the head in 2 hips(type ); low signal intensity around intermediate signal area in outer part of the head was seen in 1 hip(type V). In axial images, 6 types were identified. Type I was seen in 4 hips, type in 4 hips, type in 2 hips, type in 2 hips, type V in 1 hip and type Xshaped band of low signal intensity in the head of one hip. Morphometric analysis of radiographs of 10 hips showed 6 hips had evidence of osteonecrosis.ConclusionMRI examination should be performed in cases of ANFH confirmed in one hip, hip pain with the history of alcohol drinking and hip pain with healed fracture of the femoral neck. The correct percentage for diagnosis of ANFH was nearly 100%by MRI versus that of 60%by radiograph.

关 键 词：股骨头坏死 NMR 成像 X线诊断 

分 类 号：R681.804[医药卫生—骨科学]