血友病性关节病的X线和MRI分析

目的探讨血友病性关节病的X线和MRI表现及临床价值。方法回顾性分析8例16个膝关节血友病性关节病患者的X线和MRI表现。结果X线平片显示关节肿胀、密度增高7例，骨质疏松5例，骨性关节面破坏5例，骨端（骨骺）增大变方、股骨髁间凹增宽加深5例，方形髌骨3例，关节变形、脱位3例，软组织钙化1例；MRI表现8例16个膝关节均有积血，出血位于关节腔、骨内和／或软组织，血肿在T1WI为等信号或混杂信号、T2WI呈高信号或混杂信号。关节囊肿胀、滑膜增厚6例，关节内韧带肿胀7例，关节软骨及半月板侵蚀吸收7例，关节软骨下骨质吸收7例，关节骨质囊变3例，骨端（骨骺）增大、股骨髁间凹增宽加深5例，关节变形、脱位3例，关节肌肉萎缩2例。结论X线平片能清楚显示血友病性关节病的早期关节肿胀和中晚期骨关节特征性改变，可做为初诊的检查方法。MRI能更准确显示关节出血部位和范围、关节损害的程度及软组织改变，对疾病分级和临床诊疗、疗效评价具有重要的指导意义。

Features of X-ray and MRI of hemophilic arth ropathy

Objective To evaluate the features and clinical value of X-ray and MRI in the diagnosis of hemophilic arthropathy.Methods Features of X-ray and MRI in 8 cases(16 knee joints)with hemophilic arthropathy were analyzed retrospectively.Results Signs of X-ray were as follows:swelling of the joint with increased density in 7 cases, rarefaction of bone in 5 cases,destruction of the bony articular surfaces in 5 cases,square and enlargement of bone termination(epiphysis),square patellas and enlarged intercondylar fossae of distal femur in 5 cases,square-shaped patella in 3 cases,allaxis and dislocation of knee joint in 3 cases,calcification in the soft tissue in 1 case;MRI signs were as follows:blood accumulation were showed in all 8 cases(16 knee joints),manifested as hematoma within joint cavity,bone and/or soft tissue,iso-intensed or mixed intensities on T1WI and hyper-intensed or mixed intensities on T2WI.swelling of the articular bursas and synovium in 6 cases,swelling of the ligaments in 7 cases,destruction of articular cartilage and meniscus in 7 cases,destruction of facies articularis ossium in 7 cases,cystic changes of articular bones in 3 cases,square and enlargement of bone termination(epiphysis),square patellas and enlarged intercondylar fossae of distal femur in 5 cases, allaxis and dislocation of knee joint in 3 cases,sweeny in 2 cases.Conclusion X-ray may be a primary diagnostic method because it can clearly demonstrate the swelling of the joint and the characteristic changes of bones.While joint. locus and amplitude of articular hemophilic,degree of articular destruction,the change of the soft tissue all can be viewed on MRI,which is very helpful for the grading,clinical diagnosis and treatment of the disease and effect evaluating of the therapy.