股骨头坏死MRI脂肪抑制像软骨下低信号带与软骨下骨折的相关性分析  

Low-intensity band on fat-suppressed MR image associated with subchondral fractures in patients with osteonecrosis of femoral head

作　　者：魏秋实 何伟 洪志楠 杨帆[2] 沈莹姗 李子祺 陈镇秋[3] 郑越生 WEI Qiu-shi;HE Wei;HONG Zhi-nan;YANG Fan;SHEN Ying-shan;LI Zi-qi;CHEN Zhen-qiu;ZHENG Yue-sheng(Department of Joint Diseases,the Third Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou,Guangdong 510240,China;不详)

机构地区：[1]广州中医药大学第三附属医院关节骨科,广东广州510240 [2]广州中医药大学骨伤科研究所 [3]广州中医药大学第一附属医院 [4]广州中医药大学金沙洲医院

出　　处：《中国骨与关节损伤杂志》2020年第10期1009-1012,共4页Chinese Journal of Bone and Joint Injury

基　　金：国家自然科学基金(81873327,81573996);广东省自然科学基金(2017A030313698)。

摘　　要：目的观察ARCOⅡ、Ⅲ期股骨头缺血性坏死患者MRI脂肪抑制像软骨下低信号带与软骨下骨折的相关性。方法纳入自2016-12—2018-09确诊的304例(500髋)股骨头缺血性坏死,ARCOⅡ期257髋,ARCOⅢ期243髋。观察MRI脂肪抑制像软骨下低信号带与CT显示软骨下骨折的特征,选取行全髋关节置换术治疗的股骨头缺血性坏死患者的股骨头50髋,将股骨头标本与MRI、CT表现进行对比分析。结果MRI脂肪抑制像可见软骨下低信号带的ARCOⅡ、Ⅲ期股骨头缺血性坏死患者出现疼痛症状、骨髓水肿、软骨下骨折的概率更高。Spearman相关性分析显示,MRI脂肪抑制像软骨下低信号带与疼痛(r=0.686,P<0.001)、软骨下骨折(r=0.654,P<0.001)、骨髓水肿(r=0.547,P<0.001)、ARCO分期(r=0.485,P<0.001)呈正相关。股骨头缺血性坏死病理标本证实MRI脂肪抑制像软骨下低信号带是软骨下骨折线。结论ARCOⅡ、Ⅲ期股骨头缺血性坏死患者MRI脂肪抑制像软骨下低信号带提示软骨下骨折或塌陷,预示着股骨头不稳定,可为塌陷前股骨头缺血性坏死合理选择保髋治疗方法提供依据。Objective To observe the correlation between the low-intensity band on fat-suppressed MR image of patients with ARCOⅡ,Ⅲstage osteonecrosis of femoral head(ONFH)and the subchondral fractures.Methods A total of 304 cases(500 hips)of ONFH from December 2016 to September 2018 were included,257 hips in ARCO stageⅡ,and 243 hips in ARCO stageⅢ.The characteristics of subchondral low signal band on MRI fat suppression image and subchondral fractures from CT images were observed.Fifty femoral heads from patients with ONFH undergoing total hip arthroplasty were selected,and the femoral head specimens and MRI and CT findings were compared and analyzed.Results The patients with ARCOⅡandⅢstage ONFH with the low signal band on MRI fat suppression image had a higher rate of pain,bone marrow edema,subchondral fracture.Spearman correlation analysis showed that the subchondral low signal band on MRI fat suppression was positively correlated with pain(r=0.686,P<0.001),subchondral fractures(r=0.654,P<0.001),bone marrow edema(r=0.547,P<0.001),and ARCO staging(r=0.485,P<0.001).Pathologic specimens of ONFH confirmed that the subchondral low signal band on MRI fat suppression image was a subchondral fracture line.Conclusion The subchondral low signal band on MRI fat suppression image in patients with ARCO stageⅡandⅢONFH suggests subchondral fractures or collapse,indicating that the femoral head is unstable.It can provide a basis for the rational selection of hip preserving therapy for ONFH patients before collapse.

关 键 词：股骨头缺血性坏死 软骨下骨折 核磁共振成像 脂肪抑制像 ARCO分期 

分 类 号：R683.4[医药卫生—骨科学]