影像基础:股骨头骨骺缺血性坏死

2022-09-15 华夏影像诊断中心 华夏影像诊断中心

发病年龄多见于5-8岁男孩,病因不明,坏死部位因加之关节力学压力引起变形,与髋臼不合,导致各种股骨头半脱位。

发病年龄多见于5-8岁男孩,病因不明,坏死部位因加之关节力学压力引起变形,与髋臼不合,导致各种股骨头半脱位。

本病一般经过5期病程后得以修复,X线可现实各个病期相对应的骨骺异常改变。

1、初期(滑膜炎期):股骨头骨质无明显异常改变,但滑膜组织炎症造成内侧关节间隙增大,称之为Waldenstrom征,MRI可用于坏死的早期发现,坏死病灶T1、T2呈低信号,PDWI呈高信号。

2、坏死期(致密期):骨骺受压呈扁平状,局部骨质密度增高,可见到股骨头软骨下骨折线(侧位片更易观察到)

3、再生期(分节期);坏死骨被从周围进入的毛细血管肉芽组织所吸收,并被新生的骨替换,致密化、扁平化的骨骺变成分节状,透明区是富含血管的肉芽组织、软骨性骨化部和无钙化的类骨组织,这一时期股骨头半脱位,股骨颈变短或横径增大。

4、再骨化期(修复期):坏死骨的吸收和骨再生同时进行,骨的透明部逐渐成为正常的骨密度改变。

5、残留期:坏死骨被新生骨所替代,并可见骨小梁形成,最终因病变程度差异残留各种各样的变形,坏死病灶得以修复。

本病坏死范围Catterall分类分为四型,一般1-4型的预后不良逐渐加重,坏死骨虽然经过2-3年会被修复,但明显残留股骨头变形或脱位等,导致髋关节不稳,引起变形性髋关节症。

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    2022-02-13 redcrab
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    2021-11-07 millore
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    2021-11-07 huagfeg