股骨头骨髓水肿综合征的临床及磁共振影像特征  

Clinical and MRI features of bone marrow edema syndrome of femoral head

作　　者：段涛[1] 丁长青[2] 邓斌 潘荣雷 谢波[1] 王文生[2] 罗慧[2] Duan Tao;Ding Changqing;Deng Bin;Pan Ronglei;Xie Bo;Wang Wensheng;Luo Hui(Department of Orthopedics,the People′s Hospital of Fengxian,Fengxian 221700,China;Department of Imaging,the People′s Hospital of Fengxian,Fengxian 221700,China;Department of Orthopedics,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]徐州市丰县人民医院骨科,221700 [2]徐州市丰县人民医院影像科,221700 [3]徐州医科大学附属医院骨科,221000

出　　处：《中华诊断学电子杂志》2020年第4期237-241,共5页Chinese Journal of Diagnostics(Electronic Edition)

基　　金：江苏省卫生厅医学科研立项课题(YG201419)。

摘　　要：目的探讨股骨头骨髓水肿综合征的临床及磁共振成像(MRI)特征。方法回顾性分析2014年10月至2019年7月徐州市丰县人民医院及徐州医科大学附属医院骨科经MRI诊断并临床随访证实的60例股骨头骨髓水肿综合征患者的资料,所有患者均行冠状位T1WI、T2WI、脂肪抑制序列扫描,分析其临床及MRI特征,并对治疗前后髋关节功能(Harris)评分及世界卫生组织生存质量量表(WHO-QOL)评分进行比较。结果所有患者均为单髋关节发病,临床表现为不同程度的单侧髋部疼痛、跛行及下肢活动受限。MRI可见患侧股骨头关节面光整,股骨头颈及股骨粗隆片状脂肪抑制序列高信号。给予保守治疗1个月,治疗后Harris评分[(85.31±3.75)分]及WHO-QOL评分[(93.48±6.91)分]均明显优于治疗前[(61.08±4.29)分,(65.02±4.61)分],均差异有统计学意义(t=12.60,12.86;均P<0.01)。随访2个月至2年,患者疼痛消失时间29 d至14个月,平均(5.72±1.25)个月,37例行MRI复查的随访患者中,35例患者的疼痛消失时间早于MRI脂肪抑制序列上高信号消失时间。结论股骨头骨髓水肿综合征不同于股骨头坏死,MRI上以股骨头关节面光整、脂肪抑制序列片状高信号为特征,保守治疗可以治愈。Objective To explore the clinical and MRI features of bone marrow edema syndrome(BMES)of femoral head.Methods From October 2014 to July 2019,the data of 60 patients with BMES of femoral head diagnosed by MRI and confirmed by clinical follow-up in Orthopedics Departments of the People′s Hospital of Fengxian and the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed.All patients underwent coronal T1WI,T2WI and fat suppression sequence scans of MRI,the MRI and clinical features were analyzed.The pain domain scores in the Harris hip scores system and the WHO quality of life(WHO-QOL)scores before and after treatment were compared.Results All patients were unilateral hip involved,and the clinical manifestations were unilateral hip pain,claudication and limited lower limb movement.The articular surfaces of the affected femoral head were smooth and the femoral head,neck and trochanter were high signal on fat suppression sequence of all MRI.After one month of conservative treatment,both the Harris hip scores and the WHO-QOL scores[(85.31±3.75)points,(93.48±6.91)points]were significantly higher than those before treatments[(61.08±4.29)points,(65.02±4.61)points](t=12.60,12.86,all P<0.01).During the follow-up period from 2 months to 2 years,the pain disappeared from the time of 29 days to 14 months,with an average(5.72±1.25)months.For the 37 patients undergoing MRI re-examinations after treatment,the time of pain disappearance in the 35 cases was earlier than that of high signal disappearance on fat suppression sequence images.Conclusion BMES is different from the femoral head necrosis,is characterized by smooth articular surface of femoral head and flaky high signal in fat suppression sequence on MRI,and it can be cured by conservative treatment.

关 键 词：骨髓水肿综合征 髋关节 股骨头坏死 磁共振成像 诊断 鉴别 

分 类 号：R551.3[医药卫生—血液循环系统疾病]