激素性股骨头坏死与股骨头、颈部骨髓脂肪含量关系的MRI研究

摘要

Objective To investigate the relationship between bone marrow fat content of femoral head- neck and femoral head osteonecrosis in corticosteroid- treated patients. Methods Twenty seven patients aged above 18 years, with rheumatoid arthritis (n=12), ankylosing spondylitis (n=10) or renal transplantation (n=5), who had no history of hip disorders and previous corticosteroid treatment, underwent corticosteroid treatment. MRI examinations were performed before and 25, 50 weeks after the initiation of corticosteroid therapy. The bulk T1 signal intensity values were measured by GE/AW4.2 work station. If MRI showed femoral head osteonecrosis, the pathology examination was fol owed. t test was used (P<0.05) for statistical analysis. Results Four patients developed lateral femoral head osteonecrosis (2 in right and 2 in left)at week 25. The mean base T1 value of femoral head- neck before corticosteroid treatment was significantly shorter in femoral head osteonecrosis than that in normal femoral head (P<0.05). Conclusion The development of corticosteroid associated femoral head osteonecrosis is correlated with a high fat content in the marrow of femoral head- neck before corticosteroid therapy.%目的：通过MRI检查研究激素性股骨头坏死与股骨头、颈部骨髓脂肪含量的关系。方法对18周岁以上，无任何髋关节疾病及糖皮质激素治疗病史的27例患者（其中类风湿性关节炎12例，强直性脊柱炎10例，肾移植5例），在正规糖皮质激素治疗前后作MRI检查并进行随访，包括糖皮质激素治疗前基础MRI检查及糖皮质激素治疗后（基础MRI检查后）25、50周共2次随访MRI检查。采用GE/AW4.2工作站提供的T1信号值测量软件对基础MRI检查的股骨头、颈部骨髓进行T1信号值测量；MRI显示股骨头坏死者均经活检病理检查证实。结果4例发生股骨头坏死（左右侧各2例）。所有患者左右侧股骨头、颈部大范围平均T1信号值均无明显统计学差异（均P＞0.05）。发生股骨头坏死者的股骨头、颈部大范围平均T1信号值均较无股骨头坏死者明显减小，差异均有统计学意义（均P＜0.05）。结论激素性股骨头坏死的发生与激素治疗前的股骨头、颈部骨髓高脂肪含量有关。