股骨头骨骺滑脱的X线诊断.DOCVIP

临床医学论文-股骨头骨骺滑脱的X线诊断 ???????????????????? 作者：李建军，孔繁荣，秦树光 【关键词】? 股骨头；骨骺滑脱；X线诊断 ??? ［摘? 要］ 目的：探讨股骨头骨骺滑脱的X线表现，着重分析早期和轻度滑脱的X线征象及原因。方法：21例均照骨盆前后位平片，18例加照蛙式髋关节侧位片，15例作了CT、MRI检查。结果：中度以上滑脱者5例，早期轻度滑脱者16例。其X线表现：骺线增宽或明显增宽者10例。后倾角增大，部分骺线内窄外宽者7例。股骨颈弯曲伴内侧皮质增厚者4例。并发缺血坏死者4例。结论：骨盆前后位特别是蛙式位髋关节侧位片联合应用CT、MRI对早期轻度的股骨头滑脱有一定的诊断价值。 　　［关键词］ 股骨头；骨骺滑脱；X线诊断 　　Xrays Diagnosis of Slipped Femoral Capital Epiphysis 　　Abstract：Objective The Xray exhibition of slipped capital femoral epiphysis(SCFE) were discussed,emphasizes analyse the Xrays sign and reasons of SCFE with earlier period and mild degree.Methods Anteroposterior film were all screened for all 21 cases,among the 21 cases,18 cases were added to screen with breaststroke and lateral Xray,15 cases were examined with CT and MRI.Results 5 cases were middling SCFE and even over,16 cases having early and mild SCFE.Its Xray exhibition:Epiphyseal line were increased obviously for 10 cases.Posterior tilt angle was increscent and part epiphyseal line was narrow inside and wide outside for 7 cases.Femoral neck was curving and inside cortex was incrassated for 4 cases.4 cases were avascular necrosis.Conclusion Pelvic anteroposterior and especially frog position and lateral xray for hip joint have some certain diagnostic value with CT and MRI for early and mild SCFE. 　　Key words：Femoral head；Slipped epiphysis；Xray diagnosis ??? 股骨头骨骺滑脱(SCFE)在我国青少年中比较罕见。在美国以黑人居多。随着我国人民生活水平的提高，肥胖儿童的增加。目前该病在我国呈上升趋势，此病多发生在10岁～16岁发育期的青少年，男多于女，明显的滑脱诊断不难。但其早期和轻度的滑脱，X线表现不典型往往漏诊。本文收集我院自1990年至2004年资料完整，X线表现典型者21例，报告如下。 　　1? 资料和方法 　　本组21例，其中男16例，女5例。年龄8岁～16岁，平均12岁。临床症状：髋、大腿、膝关节疼痛者13例，跛行者8例。单侧发病者18例，双侧发病者3例。11例有不同程度的外伤史。5例有佝偻病病史，2例有慢性肾盂肾炎，3例无明显诱因。13例体重超重。21例均照骨盆前后位片，18例加照蛙式髋关节侧位片。15例作了CT、MRI检查，3例作了ECT。 　　2? 结果 　　2.1? 骺线增宽? 本组有此表现者5例（24%，5/21），在病变早期，出现股骨头移位之前，两侧对比显示患侧较健侧骺线增宽（两者相差3 mm可确诊）。2例在骨盆前后位片上表现正常，蛙式位片显示患侧增宽。追踪观察而确诊。 　　2.2? 骺线明显增宽，内侧干骺端低位? 有此表现者10例（47%，10/21）表现骺线较对侧明显增宽，股骨内侧干骺端低位，近端股骨头内侧拐角处不能像正常一样深深地包埋在髂臼内。但患侧申通氏线尚连续（蛙式侧位片不连续），泪滴至股骨头内缘的距离两侧相差超过3 mm，股骨头位于perkin方格的内下象限，与一侧髋关节轻度脱