特发性Otto骨盆影像表现一例

2019-01-08 方晓熠 黄科峰 伍晓刚 罕少疾病杂志

女,40岁。渐进性双髋关节疼痛10余年,近来疼痛加重,不能站立行走,影响正常工作,遂来我院就诊。患者平素健康,否认类风湿关节炎、强直性脊柱炎、骨软化症、创伤等疾病。查体:患者臀部后突,髋关节4字实验阳性,直腿抬高试验30度,体温正常,查血:WBC,ESR及类风湿因子及抗“O”均正常。骨盆正位X线片检查示(图1):骨盆形态上宽下窄,双侧髋臼变深、变宽,骨质变薄,略呈弧形突入盆腔,双侧股骨头全部深入髋

病例资料
  
女,40岁。渐进性双髋关节疼痛10余年,近来疼痛加重,不能站立行走,影响正常工作,遂来我院就诊。患者平素健康,否认类风湿关节炎、强直性脊柱炎、骨软化症、创伤等疾病。查体:患者臀部后突,髋关节4字实验阳性,直腿抬高试验30度,体温正常,查血:WBC,ESR及类风湿因子及抗“O”均正常。骨盆正位X线片检查示(图1):骨盆形态上宽下窄,双侧髋臼变深、变宽,骨质变薄,略呈弧形突入盆腔,双侧股骨头全部深入髋臼内,双侧股骨颈缩短,双髋关节间隙变窄,关节面骨质增生、硬化。双侧髋关节MRI平扫(图2-3)示:双侧髋臼加深,双侧股骨头向内侧移位,未见变形,关节组成骨边缘见骨质增生改变,双侧股骨头内见小囊状异常信号灶。



讨论

Otto骨盆又称髋臼向内突出症,分为特发性和继发性两种,特发性在临床上很少见,国内外文献报道也很少,属一种先天性发育异常性疾病。它由德国外科医生Otto于1824年在骨骼标本上首次发现髋关节的髋臼异常陷入,始以Protrusioscetabuli命名,后称Otto骨盆。该病女性多见,特发性多为双侧发病,早期症状不明显,进入壮年时多合并骨性关节炎。继发性多为单侧,可见于类风湿性关节炎、强直性脊柱炎、骨质软化症、创伤等疾病,髋关节周围骨质改变明显。

本病发生的基础是髋关节在生长发育过程中,当髋臼软化时,作用于髋臼的压力,特别是来自股骨头的压力超出髋臼的承受压力时,股骨头深入髋臼,髋臼呈弧形突入骨性盆腔。其临床特点是跛行、疼痛、髋关节活动受限、骨盆前倾,腰骶椎前凸等,女性患者可因髋臼内陷而致分娩困难。该病的诊断主要是依据X线检查发现髋臼显著变深向内突出,边缘密度增高,股骨头深陷髋臼内,边缘不规则,关节缘骨质硬化、骨刺形成。另外结合MRI检查能提示髋关节发育异常和继发退行性变。对于该病的治疗,近来有研究指出应用自体股骨头骨或异体颗粒骨填充髋臼结合多孔生物型髋臼假体,配合全髋关节置换,可获得较好的疗效。

原始出处:

方晓熠;黄科峰;伍晓刚;胡艳丽; 特发性Otto骨盆影像表现一例报告. 《罕少疾病杂志》2018年第05期

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    2019-01-09 Y—xianghai

    学习了长知识

    0

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    2019-01-09 Y—xianghai

    学习了新知识

    0

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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Wed Jan 09 12:56:52 CST 2019, time=2019-01-09, status=1, ipAttribution=)]
    2019-01-09 Y—xianghai

    学习了长知识

    0

  5. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Wed Jan 09 12:56:52 CST 2019, time=2019-01-09, status=1, ipAttribution=)]
    2019-01-09 Y—xianghai

    学习了新知识

    0

  6. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Wed Jan 09 12:56:52 CST 2019, time=2019-01-09, status=1, ipAttribution=)]
    2019-01-09 Y—xianghai

    学习了长知识

    0

  7. 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    2019-01-09 Y—xianghai

    学习了新知识

    0

  8. 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    2019-01-09 Y—xianghai

    学习了长知识

    0

  9. 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    2019-01-09 Y—xianghai

    学习了新知识

    0

  10. 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    2019-01-09 Y—xianghai

    学习了长知识

    0

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