股骨头坏死的影像学表现优秀PPT.ppt

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1、股骨头坏死的影像学表现现在学习的是第1页，共30页WordsSubchondral Insufficiency Fracture：软骨下不全骨折Osteonecrosis of the Femoral Head：股骨头坏死Convex 凸ncavity 凹现在学习的是第2页，共30页软骨下不全骨折（Subchondral insufficiency fracture,简称SIFs）1、软骨下机能不全性骨折是非外伤性的一种骨折。2、最常见的病因：骨质疏松，不常见的病因是骨质软化症或骨不全症、甲状旁腺功能亢进和类风湿性关节炎等。3、发病原理：正常软骨可忍受正常的生物机械应力，当由于上述病因变得软弱

2、时，可出现软骨下骨折，并发展为软骨下萎陷，为此需认识此病作出早期诊断，多数患者经保守治疗后可自愈。现在学习的是第3页，共30页OBJECTIVEThe purpose of this article is to verify the hypothesis that osteonecrosis and subchondral insufficiency fracture of the femoral head can be differentiated on the basis of their appearance on MRI.现在学习的是第4页，共30页SUBJECTS AND METHO

3、DS 1 Between May 1998 and February 2009,we reviewed 30 consecutive hips in 30 patients,60 years old or older at the time of onset of hip pain,with radiologic evidence of subchondral collapse of the femoral head and with both MR images and histologic results available.现在学习的是第5页，共30页SUBJECTS AND METHO

4、DS 2The patients were divided into two group according to the shape of low-intensity bands on T1-weighted images.The first group showed concavity of the articular surface,which is characteristic of osteonecrosis,and the second group showed an irregular convexity of the articular surface,which is cha

5、racteristic of subchondral insufficiency fracture.现在学习的是第6页，共30页A In osteonecrosis,low-intensity band is smooth,concave to articular surface,and circumscribes all of necrotic segments.B In subchondral insufficiency fracture,low-intensity band is irregular,convex to articular surface,and discontinuou

6、s.现在学习的是第7页，共30页RESULTSSixteen hips(53.3%)showed evidence of osteonecrosis,and 14(46.7%)showed evidence of subchondral insufficiency fracture,which was consistent with the corresponding histopathologic diagnoses.In all cases of osteonecrosis,the patient had a history of either corticosteroid intake

7、or alcohol abuse.Among patients with subchondral insufficiency fracture,the proportion of women was significantly higher than that among patients with osteonecrosis.A crescent sign(subchondral fracture)was present radiographically in about half of all cases in both groups.现在学习的是第8页，共30页TABLE 1:Clini

8、cal Characteristics of Patients With Osteonecrosis or Subchondral Insufficiency Fracture现在学习的是第9页，共30页CONCLUSIONThe results of the present study suggest that the shape of the low-intensity band on MRI is useful for the differentiating subchondral insufficiency fracture from osteonecrosis.In addition

9、,among osteoporotic elderly women without any history of corticosteroid intake or alcohol abuse,a diagnosis of subchondral insufficiency fracture should be considered.现在学习的是第10页，共30页64-year-old man with history of alcohol abuse and osteonecrosis.A,Anteroposterior radiograph of left hip(Singh index o

10、f severity of osteoporosis,grade V)obtained at time of onset of pain shows both crescent sign and collapse of femoral head at superolateral portion(arrows).现在学习的是第11页，共30页B,Coronal T1-weighted image(TR/TE,470/15)shows diffuse low signal intensity in femoral neck at lateral portion and intertrochante

11、ric area.Low-intensity band on T1-weighted image is concave to articular surface(arrows).现在学习的是第12页，共30页“线样征”位于股骨头颈前上部病灶周围多呈空间锥形分布,锥尖指向股骨头基底部或股骨颈。Glimcher认为修复开始后,肉芽组织自股骨颈或股骨头基底部向死骨区爬行。肉芽组织到达并吸收骨皮质时,皮质承载力减弱。在重力作用下自此皮质薄弱区于松质骨内产生多条微骨折线,因应力作用微骨折线多位于股骨头前上部周围。肉芽组织在微骨折处大量增生堆积、吸收坏死骨小梁并于外围大量成骨,从而形成T2WI上的“双线症

12、”。现在学习的是第13页，共30页D,Axial slice of T1-weighted image(500/15)shows that low-intensity band circumscribes all of necrotic segments(arrows).现在学习的是第14页，共30页E,Cut section of resected femoral head shows zonal pattern(necrotic,reparative,and viable zones).Subchondral fracture line(arrow)corresponding to cre

13、scent sign on radiograph(A)is seen.现在学习的是第15页，共30页新月征形成机制因皮质断裂塌陷时,关节软骨在一段时间内尚保持完整,形成软骨下负压。股骨头体液内气体在负压作用下溢出并进入囊腔。现在学习的是第16页，共30页现在学习的是第17页，共30页F,Histopathologic appearance of necrotic region,which shows accumulation of bone marrow cell debris,and bone trabeculae with empty lacunae beneath fracture li

14、ne are seen.(H and E,40)现在学习的是第18页，共30页G,There is repair tissue in reparative zone,including vascular granulation tissue,fibrous tissue.(Hand E,20)现在学习的是第19页，共30页Fig.375-year-old woman,without history of either corticosteroid intake or alcohol abuse,with subchondral insufficiency fracture.Anteropost

15、erior radiograph of left hip(Singh index of severity of osteoporosis,grade V)obtained at time of onset of pain shows both crescent sign and collapse of femoral head at superolateral portion(arrows).现在学习的是第20页，共30页The frequency of the crescent sign in the subchondral insufficiency fracture group was

16、similar to that in osteonecrosis group in the current study,thus indicating that the crescent sign is not sufficient to differentiate osteonecrosis from subchondral insufficiency fracture.现在学习的是第21页，共30页B,Coronal T1-weighted image(TR/TE,470/25)shows diffuse low signal intensity in femoral head and n

17、eck.Low-intensity band is parallel to subchondral bone endplate(arrows).The low-intensity band on T1-weighted images in subchondral insufficiency fracture corresponds histologically to the fracture line and associated fracture repair tissue.Therefore,the shape of the low-intensity band generally ten

18、ds to be irregular,disconnected,and convex to the articular surface.现在学习的是第22页，共30页D,Axial slices of T1-weighted image(500/15)show low-intensity band mainly in anterior region,which is interrupted in middle(arrows).现在学习的是第23页，共30页E,Fat-saturated contrast-enhanced MRI(from image shown in D)(605/14)in

19、 which part of proximal portion beyond low-intensity band shows contrast enhancement indicating perfusion(arrows).现在学习的是第24页，共30页F,Cut section of resected femoral head shows subchondral fracture line(black arrow)and whitish linear shaped area beneath articular cartilage(white arrow).现在学习的是第25页，共30页G

20、,Band region histopathologically corresponds to fracture callus,reactive cartilage,and granulation tissue.(H and E,40)现在学习的是第26页，共30页现在学习的是第27页，共30页Limititions 样本量小对于软骨下不全骨折早期表现，如软骨下水肿，由于在平片上未见异常，未被纳入。仅4例进行了增强MR检查。现在学习的是第28页，共30页真爱生命，拒绝酒精真爱生命，拒绝酒精现在学习的是第29页，共30页统计学方法Statistical analyses were perform

21、ed using Fishers exact probability test with regard to sex,a history of corticosteroid intake or alcohol abuse,and the radiologic findings(i.e.,demarcating sclerosis,crescent sign,and vertebral compression fracture).Age and BMI of groups A and B were compared using the unpaired Students t testthe Singh index was compared using the Mann-Whitney U test.Statistical analyses were performed using StatViewJ-5.0 software(SAS Institute),and p values less than0.05 were considered to be statistically significant.现在学习的是第30页，共30页