成人股骨头缺血性坏死的早期CT征象.DOCVIP

临床医学论文-成人股骨头缺血性坏死的早期CT征象 【关键词】? 股骨 ??? ［摘? 要］ 目的：探讨成人股骨头缺血性坏死（ANFH）的早期CT征象并指导临床治疗。方法：对临床疑诊ANFH的全部病例均行X线平片及CT检查，分析ANFH的早期CT征象。结果：早期ANFH的CT表现：31例38个股骨头，其中13个股骨头骨小梁呈放射状高密度的“星状征”，骨小梁境界清楚、锐利，属Ⅰ期；25个股骨头表现为骨硬化，骨小梁结构消失、模糊不清，骨密度减低及囊性改变，属Ⅱ期；并有5个股骨头在Ⅱ期影像学改变基础上出现软骨下骨折及轻微塌陷，属Ⅲ期。治疗结果：Ⅰ期行钻孔髓内减压术，Ⅱ、Ⅲ期行钻孔减压植骨术。结论：CT可以诊断早期ANFH并分期，而且能很好地指导临床治疗。 ??? ［关键词］ 早期；股骨头；缺血性坏死；CT ??? The Early Signs of Avascular Necrosis of Femoral Head in Adult with CT ?????? Abstract：Objective To evaluate early signs of avascular necrosis of femoral head in adult (ANFH) by CT and to guide clinical treatment.Methods The cases with suspicious diagnose of ANFH were scaned in the both hip joints by Xray and CT to find the early signs of ANFH with CT.Results Early signs of ANFH using CT showed that, in 38 femoral heads 31 cases, there were radiate star shape of highdensity osteosclerosis of the trabeculae (stageⅠ) in 13 femoral head.Twentyfive femoral heads showed osteosclerosis and trabeculae structure disappearing and vague,incoordinately lowostedensity area and cyst change (stageⅡ).There were fracture under the cartilage and light subsid in 5 cases (stageⅢ).The cases in stage Ⅰwere given decompression, while the pationtsresul in stageⅡand stageⅢ were given decompression and ostetransplant.Conclusion CT results show that the sign of the highosteodensity and low osteodensity and cyst change can disply early ANFH. It can also instruct the clinical treatment of ANFH. ??? Key words：Early；Femoral head；Avascular necrosis；CT ??? 成人股骨头缺血性坏死（avascular necrosis of femoral head in adult, ANFH）是髋关节常见病，本病一旦出现临床症状，病情将持续发展，出现股骨头塌陷，最终导致骨关节炎，造成严重病废［1］，如何能发现病变早期征象是治疗本病的关键。本文回顾性分析临床疑诊为ANFH的38个股骨头的X线平片及CT影像学资料，结合复习相关文献，探讨ANFH的早期CT征象并指导临床治疗。 ??? 1? 材料与方法 ??? 1.1? 一般资料? 笔者搜集2003年3月至2004年9月间，我院临床疑诊为ANFH的31例股骨头的X线平片及CT影像学资料。其中男19例，女12例，年龄28岁～51岁，平均34岁。6例合并强直性脊柱炎。左侧20例，右侧18例，7例为双侧。本组患者均有患侧腹股沟区、髋部及大腿疼痛，可伴有跛行，髋关节活动受限。 ??? 1.2? 检查方法? CT检查采用GE ProSpeed AI 螺旋全身CT扫描仪。层厚4 mm或8 mm，层间距0 mm~1 mm，矩阵512×512；患者仰卧行股骨头横断面扫描，摄有软组织窗及骨窗两种图像。X线平片为双侧髋关节标准正