骨与关节影像诊断学.pdf

骨与关节影像诊断学 （二） 北京大学第一医院医学影像科 王继琛 骨关节结核 • 继发性结核病，血行感染 • 儿童、青少年多见 • 脊柱及髋、膝关节好发 • 临床经过缓慢 骨关节结核 • 长骨干骺端结核 •短管状骨骨干结核 • 关节结核（滑膜型） • 脊柱结核 骺和干骺端结核 • 骨质疏松 • 类圆形限局性骨质破坏 • 中间可有碎屑死骨 •周围骨增生硬化不明显 短管状骨骨干结核 • 四肢短管状骨 • 儿童多见，病变多发 • 骨质破坏在骨内呈囊性改变 • 骨膜增生使骨干增粗 • 骨气鼓征 Spina ventosa in a 22-year-old woman. Anteroposterior (a) and magnified (b) radiographs show extensive soft-tissue swelling with ballooning of the third metacarpal of the left hand. Findings of tuberculous arthritis are also seen in the adjacent joint (arrowheads) 滑膜型关节结核 • 青年人髋、膝大关节常见 • 早期关节周围软组织肿胀，骨质疏松 • 关节面非持重边缘部先有先有骨质破 坏 • 关节间隙狭窄 Tuberculous arthritis in a 28-year-old man with pain. A-P (a) and magnified (b) radiographs show marginal osseous erosions of the femoral head (arrows) with relative preservation of the left hip joint space. There is also evidence of periarticular osteopenia. Tuberculous disease was confirmed with bone biopsy 脊柱结核 • 椎体破坏 • 椎间隙狭窄 • 椎旁脓肿 • 脊柱畸形 Tuberculous spondylitis in a 17-year-old girl with low back pain. (a, b) A-P (a) and lateral (b) plain radiographs show loss of vertebral body height (arrowhead in a), sclerosis of the end plates, and anterior scalloping (arrowheads in b). (c) Sagittal T1 image shows focal decreased signal intensity (arrow). Sagittal T2-weighted (d) and Gd- T1-weighted (e) MR images show increased signal intensity (arrow). Tuberculous disease was confirmed with bone biopsy Tuberculous spondylitis with psoas abscess in a 21-year-old woman. (a) Midsagittal T1-MR images show loss of vertebral body height and decreased signal intensity at T4 (arrows). (b) Coronal T2- weighted MR image of the upper dorsal spine shows bilateral paraspinal abscesses (arrows) with involvement of T4. (c, d) Axial T2-weighted (c) and parasagittal T2-weigh