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髋关节一过性骨髓 水肿综合症的临床 特征和MRI表现与 鉴别分析

作者:张 英 汪 桦 杨金妹 张威江

所属单位:南京医科大学附属无锡人民医院影 像科 (江苏 无锡 214000)

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摘要

目的 分析髋关节一过性骨髓 水肿综合症(TBMES)的临床特征及MRI 表现。方法 回顾性分析经磁共振成像 (MRI)检查、随访证实的15例TBMES患者 相关资料,观察TBMES临床特征及MRI表 现。结果 临床特征:所有患者患侧腹 股沟区压痛,活动受限;实验室检查类 风湿因子、血尿常规检查均正常;15例 中单侧髋关节受累13例;累及股骨头、 颈、股骨粗隆间12例;关节腔内积液7 例。MRI对TBMES检出率明显高于X线片, 差异有统计学意义(P<0.05)。股骨近端 病变MRI上显示T1WI低信号,T2WI高或略 高信号为主(12例),T2WI-STIR高信号; MRI显示关节腔内积液为长T1、长T2信 号;MRI显示患侧髋关节周围肌肉层次清 楚,无异常信号。随访6个月症状消失, MRI复查无复发。结论 TBMES典型特征为 髋部疼痛,MRI诊断TBMES敏感度明显高 于X线片,正确掌握TBMES主要征象有利 于其诊断及鉴别。

Objective To analyze the clinical features and MRI findings of transient bone marrow edema syndrome of the hip (TBMES). Methods Retrospective analysis was performed in 15 patients with TBMES confirmed by magnetic resonance imaging (MRI) and follow-up. The clinical features and MRI findings of TBMES were observed. Results In terms of clinical features, all patients suffering from tenderness in inguinal area and activity limitation. Laboratory examination found that rheumatoid factors, blood and urine routine were normal. Among 15 cases, there were 13 cases of unilateral hip involvement, 12 cases with involvement of femoral head, neck and femoral intertrochanteric area. 7 cases with articular cavity effusion. The detection rate of MRI in TBMES was higher than that of X-ray film (P<0.05). MRI of proximal femoral lesions showed low signal on T1WI, high or slightly high signal on T2WI (12 cases) and high signal on T2WISTIR. MRI displayed that joint cavity effusion showed long T1 and long T2 signal. MRI showed that the muscle layers around the affected side of the hip joint were clear without abnormal signal. After 6 months of follow-up, the symptoms disappeared, and there was no recurrence found by MRI review. Conclusion The typical feature of TBMES is hip pain. The sensitivity of MRI in the diagnosis of TBMES is higher than that of X-ray. Correctly grasping the main features of TBMES is conducive to the diagnosis and identification.

【关键词】髋关节;骨髓水肿综合症; 临床特征;磁共振成像

【中图分类号】R323.4+5

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2016.10.039

前言

髋关节一过性骨髓水肿综合症(Transient bone marrow edema syndrome of the hip,TBMES)具有原因不明、自限性特点,典型症状 为髋部疼痛[1],通常发病后3~6个月便可痊愈或明显缓解。TBMES在影 像学上主要表现为髋部骨质疏松,为此TBMES又称之为一过性骨质疏 松[2]。既往由于对TBMES认知不足,且发病早期骨质变化不典型,传统 X线平片检查易漏诊。近年来随着人们对TBMES认识不断深入及影像学 技术的快速发展,磁共振成像(MRI)在TBMES诊治中应用增多。但由于 TBMES与股骨头缺血性坏死临床表现、影像学存在一定的相同点,为此 临床上易混淆,不利于疾病治疗及预后。基于此,本研究对15例TBMES 患者临床及MRI表现资料进行回顾性分析,以为TBMES进一步认识、诊 治提供依据。