《股骨头坏死的影像学表现精选PPT.ppt》由会员分享，可在线阅读，更多相关《股骨头坏死的影像学表现精选PPT.ppt（30页珍藏版）》请在taowenge.com淘文阁网|工程机械CAD图纸|机械工程制图|CAD装配图下载|SolidWorks_CaTia_CAD_UG_PROE_设计图分享下载上搜索。
1、股骨头坏死的影像学表现第1页，此课件共30页哦WordsSubchondral Insufficiency Fracture：软骨下不全骨折Osteonecrosis of the Femoral Head：股骨头坏死Convex 凸ncavity 凹第2页，此课件共30页哦软骨下不全骨折（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时，可出
2、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。第3页，此课件共30页哦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.第4页，此课件共30页哦SUBJECTS AND METHODS 1 Bet
3、ween 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.第5页，此课件共30页哦SUBJECTS AND METHODS 2The pa
4、tients 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 characteristi
5、c of subchondral insufficiency fracture.第6页，此课件共30页哦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 discontinuous.第7页，此课件共30
6、页哦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 or alcohol abu
7、se.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.第8页，此课件共30页哦TABLE 1:Clinical Characterist
8、ics of Patients With Osteonecrosis or Subchondral Insufficiency Fracture第9页，此课件共30页哦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,among osteoporoti
9、c elderly women without any history of corticosteroid intake or alcohol abuse,a diagnosis of subchondral insufficiency fracture should be considered.第10页，此课件共30页哦64-year-old man with history of alcohol abuse and osteonecrosis.A,Anteroposterior radiograph of left hip(Singh index of severity of osteop
10、orosis,grade V)obtained at time of onset of pain shows both crescent sign and collapse of femoral head at superolateral portion(arrows).第11页，此课件共30页哦B,Coronal T1-weighted image(TR/TE,470/15)shows diffuse low signal intensity in femoral neck at lateral portion and intertrochanteric area.Low-intensity
11、 band on T1-weighted image is concave to articular surface(arrows).第12页，此课件共30页哦“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”。第13页，此课件共30页哦D,Axial s
12、lice of T1-weighted image(500/15)shows that low-intensity band circumscribes all of necrotic segments(arrows).第14页，此课件共30页哦E,Cut section of resected femoral head shows zonal pattern(necrotic,reparative,and viable zones).Subchondral fracture line(arrow)corresponding to crescent sign on radiograph(A)i
13、s seen.第15页，此课件共30页哦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。第16页，此课件共30页哦第17页，此课件共30页哦F,Histopathologic appearance of necrotic region,which shows accumulation of bone marrow cell debris,and bone trabeculae with empty lacunae beneath fracture line are seen.(H and E,40)第18页，此课件共3
14、0页哦G,There is repair tissue in reparative zone,including vascular granulation tissue,fibrous tissue.(Hand E,20)第19页，此课件共30页哦Fig.375-year-old woman,without history of either corticosteroid intake or alcohol abuse,with subchondral insufficiency fracture.Anteroposterior radiograph of left hip(Singh ind
15、ex 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).第20页，此课件共30页哦The frequency of the crescent sign in the subchondral insufficiency fracture group was similar to that in osteonecrosis group i
16、n the current study,thus indicating that the crescent sign is not sufficient to differentiate osteonecrosis from subchondral insufficiency fracture.第21页，此课件共30页哦B,Coronal T1-weighted image(TR/TE,470/25)shows diffuse low signal intensity in femoral head and neck.Low-intensity band is parallel to subc
17、hondral 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 tends to be irregular,disconnected,and convex
18、 to the articular surface.第22页，此课件共30页哦D,Axial slices of T1-weighted image(500/15)show low-intensity band mainly in anterior region,which is interrupted in middle(arrows).第23页，此课件共30页哦E,Fat-saturated contrast-enhanced MRI(from image shown in D)(605/14)in which part of proximal portion beyond low-int
19、ensity band shows contrast enhancement indicating perfusion(arrows).第24页，此课件共30页哦F,Cut section of resected femoral head shows subchondral fracture line(black arrow)and whitish linear shaped area beneath articular cartilage(white arrow).第25页，此课件共30页哦G,Band region histopathologically corresponds to fr
20、acture callus,reactive cartilage,and granulation tissue.(H and E,40)第26页，此课件共30页哦第27页，此课件共30页哦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。第28页，此课件共30页哦真爱生命，拒绝酒精真爱生命，拒绝酒精第29页，此课件共30页哦统计学方法Statistical analyses were performed using Fishers exact probability test with regard to sex
21、,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.第30页，此课件共30页哦