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目的分析严重急性呼吸综合征(SARS)糖皮质激素治疗后膝关节骨缺血性坏死的发生和MRI特点。方法4所医院感染SARS并经糖皮质激素治疗的医护人员共18例,均行双侧膝关节和双髋关节MR检查,确定骨坏死发生与否、病变特点及其与糖皮质激素用量的关系。结果18例中,11例出现膝关节骨坏死,3例合并双侧髋关节股骨头坏死。7例为双侧膝关节骨坏死,4例为单侧。膝关节骨坏死病灶共计38个,34个位于股骨内、外侧髁以及相邻的股骨干,4个位于胫骨内或外侧髁。膝关节骨坏死的大、中病灶多为不规则形,周边呈细带状低信号,其中4个在T2WI上可见“双边征”;坏死灶内T1WI多为等或稍低信号,T2WI多为高、等或混杂信号。小病灶在T1WI上为低信号,T2WI上多为低或高信号。髋关节股骨头坏死灶位于其中上部、软骨下,呈类椭圆形异常信号,病灶内T1WI为等信号,T2WI为高或混杂信号;周边有不规则低信号带,其中1例双侧病灶T2WI上可见“双边征”。结论该组SARS病例糖皮质激素治疗后骨缺血性坏死以膝关节为多,对这类病人应注意早期行膝关节MR检查。膝关节坏死以股骨内、外侧髁和相邻的股骨干最多见,胫骨内外、侧髁亦可发生。骨缺血性坏死的发生及严重程度与静脉糖皮质激素用量有关。
Objective To analyze the occurrence and MRI features of knee osteoarthritis after severe acute respiratory syndrome (SARS) treated with glucocorticoid. Methods A total of 18 medical staff who were hospitalized with SARS and treated with glucocorticoid were enrolled in this study. All patients underwent bilateral knee and double hip MR examinations to determine whether osteonecrosis occurred or not, pathological features and its relationship with glucocorticoid dosage . Results In 18 cases, osteonecrosis of the knee occurred in 11 cases and osteonecrosis of the femoral head in 3 cases with bilateral hip joint. Seven cases were bilateral knee osteonecrosis, and four cases were unilateral. A total of 38 lesions were found in the osteonecrosis of the knee joint, 34 in the medial femoral condyle and the adjacent femoral shaft, and 4 in the medial or lateral tibial condyle. Knee osteonecrosis of the large and medium lesions mostly irregular shape, the surrounding fine ribbon-shaped signal was low, four of which can be seen in the T2WI “bilateral sign”; T1WI necrosis lesions were more or less signal, T2WI mostly High, equal or mixed signals. Small lesions in the T1WI low signal, T2WI mostly low or high signal. Hip femoral head necrosis in which the upper, subchondral, was oval-like abnormal signal lesions T1WI is equal signal, T2WI is high or mixed signal; around the irregular low signal band, including 1 case of bilateral lesions T2WI Visible “bilateral sign.” Conclusion This group of SARS cases of glucocorticoid treatment of ischemic necrosis of the knee to more patients should pay attention to early knee MR examination. Knee joint necrosis to the femur, lateral condyle and adjacent femoral shaft is the most common, lateral and lateral tibia, lateral condyle can occur. The incidence and severity of ischemic necrosis are related to the amount of intravenous glucocorticoid.