长管状骨非潜水性骨梗死7例X线CT表现分析.DOCVIP

临床医学论文-长管状骨非潜水性骨梗死7例X线CT表现分析 ［摘? 要］ 目的:总结7例长管状骨非潜水性骨梗死的X线、CT表现,探讨长管状骨非潜水性骨梗死的X线、CT诊断价值。方法:7例患者均拍摄了X线平片、CT检查；2例手术活检。结果：7例长管状骨非潜水性骨梗死共累及10个部位，股骨下段4个，胫骨上段4个，胫骨下段2个。其中2个部位经手术活检病理证实。X线平片显示髓腔内不均匀性骨化，CT显示髓腔内呈地图样改变，周围环以硬化边。结论:X线平片可以满足中晚期骨梗死的诊断，CT检查可以进一步明确诊断。 　　［关键词］ 骨梗死；长管状骨；CT、X线诊断 　　The Analysis of the Imaging Manifestation on the Long Tubal Nondiver Bone Infar CTion in 7 Cases 　　Abstract:Objective To explore the diagnosis fingings of;nondiver bone infar CT ion on plain radiography and CT,by imaging manifestation in 7 cases.Methods all of patients were examined by plain radiography and CT.two of them were confirmed by biopsy.Results Ten sites of the bone infarct in 7 patients were found,including 4 in the distal femur,4 in the proximal tibia,2 in the distal tibia.Two lesion sites in these patients were confirmed by operation and pathology.Plain radiography manifestation was inhomogeneous ossification in the intramedullary cavity.CT manifestation was “mapshaped”lesions with the surrounding sclerotic rim in the intramedullary cavity.Conclusion Plain radiography can suffice for diagnosing the bone infarCT in the middle and later stages.CTexamination can obtain more sensitive diagnosis than plain radiography. 　　Key words：Bone infar;CTion;Long tubal bone;Computed tomography and plain radiography diagnosis 　　非潜水性骨梗死发病率近年来有上升的趋势，常无明显临床症状，多在摄片中偶然发现，为提高对本病影像学表现的认识，收集我院2005年7月至2006年7月所见长管状骨非潜水性骨梗死7例，结合文献，讨论如下。 　　1? 材料与方法 　　1.1? 一般资料? 7例中，男4例，女3例。年龄35岁~76岁，中位年龄49岁。病程4个月~13 a。7例均因患肢疼痛就诊，1例女性患者均有患系统性红斑狼疮使用激素治疗史，酗酒者2例，4例为高血压病。 　　1.2? 检查方法? X线检查采用PHLIPSOPTOMUS 500 mA X线机；CT检查采用东芝Aquilion 16排螺旋CT扫描仪，扫描条件：层厚5 mm、pitch 5.5、电压120 kV、电流200 mAs、矩阵512×512、滤过函数（Fc）30。 　　2? 结果 　　2.1? 骨梗死部位? 7例长管状骨非潜水性骨梗死共累及10个部位，股骨下段4个，胫骨上段4个，胫骨下段2个。其中2个部位经手术活检病理证实。 　　2.2? 影像学表现? 7例均为中晚期病变。X线平片均显示髓腔内不均匀性骨化(见图1、图2)；CT显示髓腔内呈地图样改变，周围环以硬化边(见图3、图4)。 　　2.3? 病理表现? 2例手术活检显示病变区大部分骨质退行性变,形状不规则,内有坏死,边缘部骨硬化和不均匀钙化,于病变小梁间见纤维组织增生或纤维瘢痕形成,亦见有纤维化骨,部分髓腔内见慢性炎性反应。 　　图1、图2? 女，58岁，双膝关节正位+左膝关节侧位X线平片：示左股骨下段髓腔内有不均匀的斑片状、点状钙化灶，患骨外形无膨胀、