血友病性骨关节病：附30例临床X线分析

本文报告30例血友病性骨关节病,其中1例为女性(血友病丙),X线片上可有以下10种改变:(1)关节囊、软组织肿胀;(2)关节间隙增宽或变窄;(3)骨性关节凹凸不整;(4)股骨髁间凹或鹰咀窝加深;(5)骨骺或骨端过度发育增大变方;(6)方形膑骨;(7)骨骺线或骨骺不规则;(8)关节骨性僵直;(9)骨内囊肿样变;(10)软组织内钙化。文中对上述表现进行了评价并对病理改变与X 线表现的关系进行了讨论。     

血友病性骨关节病2例报告

血友病性骨关节病较少见 ,现将我院遇见 2例 ,报告如下。例 1　男 ,14岁。自述有血友病史 ,双膝关节肿胀、疼痛、活动受限 ,前来就诊。Ｘ线片示 :左膝关节髁间隆凸变尖 ,股骨髁间凹变宽变深 ,骨骺变大呈方形 ,关节面不整 ,关节间隙变窄 ,髌骨内上呈囊状改变。诊断 :左膝关节血友病性骨关节病 (图 1)。例 2　男 ,12岁。有血友病家庭史与例 1为姨表兄弟 ,因膝关节肿痛而就诊。Ｘ线片示 :左膝关节面不整 ,骨骺略增大 ,髁间隆凸变尖 ,股骨髁间凹变宽加深 ,呈深碟样 ,骨骺线不规则 ,呈波浪状 ,关节间隙变窄。诊断 :左膝关节血友病性骨关节病 (图 …     

血友病性骨关节病的X线诊断（附15例报告）

本文报告１５例血友病性骨关节病，其中１０例为血友病甲，２例为血友病乙，１例为血友病丙，余２例未分型。均为男性。其Ｘ线表现为关节囊软组织肿胀、密度增高（１５例），骨端或骨骺增大变方（６例），关节间隙变窄、关节面硬化和囊性变（１２例），关节骨端破坏（６例），骨性关节强直（１例），股骨髁间凹和尺骨鹰咀窝增宽变深（１０例），骨膜新生骨（３例）和血友病性假肿瘤（２例）。文中分析本病的Ｘ线表现并讨论其病理基础。     

血友病性骨关节病影像学表现(附20例分析)

目的 探讨血友病性骨关节病临床及影像学表现.方法 回顾性总结 20例经过临床及实验室检查证实的血友病患者的影像学资料,结合文献资料对血友病患者病变关节的影像学表现进行分析.结果 20例共累及45个关节,其中膝关节25个,肘关节9个,踝关节8个,髋关节3个.影像学表现为关节囊软组织肿胀13例,关节间隙狭窄7例,关节面硬化和囊变6例,关节强直7例, 骨端或骨骺增大变方6例,髁间窝变宽、加深7例,板障内出血1例.结论 血友病性关节炎有其比较特征性的影像学特点,结合临床及相关血液学检查可以明确诊断.     

镰状细胞贫血的骨关节表现

作者研究57例镰状细胞贫血的骨关节改变。骨坏死为常见X线征,其次为骨髓炎,而关节炎少见。X线表现:骨坏死多累及干骺端,最常见于股骨上、下干骺端和胫骨上干骺端。广泛骨梗塞见于骨干和干骺端的骨皮质。X线表现为管状骨皮质增厚和硬化以及髓腔内新骨形成、髓腔狭窄和骨膜反应。长骨骨骺骨化中心的缺血坏死表现为斑片状硬化、碎裂、变扁和关节破坏。在髋关节表现为扁平髋。髋臼缺血坏死的表现是髋关节间隙增宽和髓臼     

血友病性骨关节病1例

患者男性，16岁，因下肢进行性疼痛3年余入院，以右下肢明显，无发热等症状。查体：右膝关节肿胀、僵直。X线检查：右膝关节间隙明显变窄，关节面平坦，软骨下骨质可见大小不等的囊状骨质破坏，髁间凹变深增宽，诊断为血友病性骨关节病。     

血友病性关节炎及髂骨巨大假肿瘤1例报告

血友病性髂骨多发巨大骨囊肿样变罕见 ,我院发现 1例 ,现报告如下。患者　男 ,5 3岁 ,左髂骨反复疼痛 1年余 ,近 1周加重。查体 :左髋部肿胀 ,压痛 ,屈髋功能受限。Ｘ线骨盆平片 :左髂骨成多发大片状溶骨区 ,呈膨胀性生长 ,内见少数不规则房隔 ,周边骨皮质变薄。髂前下棘可见病理性骨折。周围软组织肿胀 (图 1)。Ｘ线诊断 :动脉瘤样骨囊肿 (中央型 )。进一步了解病史 ,患者 12年前确诊为血友病 (甲 )。进一步查体 :双膝关节肿胀 ,活动受限。加拍双膝关节正侧位片 (图2 ) :双膝关节间隙狭窄 ,股骨髁间凹及鹰嘴窝变宽增深 ,呈典型的血友病性关…     

MRI诊断血友病性骨关节病1例

1病例报告 患者,男,19岁,扭伤后右膝疼痛2年,15年前确诊为血友病A。体检：贫血貌,右膝关节肿胀畸形,压痛明显,活动受限。实验室检查：出血时间（BT）20min 18s,活化部分凝血活酶时间（APTT）48．7s,凝血因子Ⅷ：C：3％。MRI表现：右膝关节间隙变窄,右膝关节缘、髌骨缘增生,变尖,关节软骨变薄。右股骨下端、胫骨上端、髌骨关节面下骨质内、右膝关节周围软组织内多发斑片状异常信号,T1WI／T2WI均为低信号。右膝关节腔、髌上囊内大量异常信号,L1WI为低信号,T2WI为高信号（图1—4）。MRI诊断：血友病性骨关节病。     

血友病性关节病的MRI分析

目的:探讨血友病性关节病的MRI表现及临床价值.方法:回顾性分析11例22个膝关节血友病性关节病患者的MRI表现.结果:22个膝关节均有积血,表现为关节腔、骨骼和/或软组织血肿,早期血肿在T1WI为等信号、T2WI呈高信号;中期血肿在T1WI呈略高信号或混杂信号,T2WI呈高信号或混杂信号;晚期血肿在T1WI和T2WI均表现为混杂信号,血肿逐渐被吸收.病变早期关节结构基本保持正常,中晚期关节结构均有损害,表现为关节软骨、骨皮质破坏吸收,关节间隙狭窄,骨端或骨骺增大变形.早中期滑膜、关节囊、肌肉及韧带肿胀,而晚期则萎缩、退变.结论:MRI能准确显示血友病性关节病的病理改变,对疾病分期、指导临床治疗及同位素放射治疗效果评价具有重要意义.     

多发性骨骺发育异常一例

患者　女 ,6岁。右膝关节疼痛、僵硬、跛行 1年。体检 :身高 98ｃｍ ,体重 19ｋｇ ,摇摆步态 ,双膝内翻畸形 ,双膝关节略大于同龄儿童 ,智力正常。其他物理检查及实验室检查无阳性发现。既往及家族史无特殊 ,居住区无地方病。Ｘ线表现 :两膝关节组成骨对称性骨骺及干骺端不规则 ,发育不良。骨骺内薄外厚 ,其内外两侧呈分节状和斑点状碎裂 ,胫骨干骺端呈斜坡状并向外突出 ,股骨髁及胫骨髁成角。髁间凹变浅 ,髌骨呈斑点状。干骺端及骨骺无骨增生硬化现图 1、2　两膝关节组成骨对称性骨骺及干骺端不规则 ,发育不良。股骨骨骺内外两侧呈分节状和…     

双手类风湿性关节炎早显X线征象探讨

文献上对早期类风湿性关节炎X线诊断认识并不一致。本文根据双手骨关节X线改变及软组织X线改变两组征象研究了44例早期类风湿性关节炎,并与同一时期作检查的系统性红斑狼疮22例,慢性肾衰40例,痛风8例,及骨关节病18例作了比较。我们归纳的早期X线征象为:关节旁骨质疏松;软组织肿胀;关节边缘侵独;及关节间隙狭窄。     

成骨不全:特殊表现

目的：观察成骨不全的特殊表现,探讨其形成机制和预后。材料与方法：对６８例成骨不全的临床与Ｘ线片资料进行回顾性分析。结果：本组成骨不全中,２３例有特殊表现,包括：（１）正常骺板变模湖或消失,骨骺、干骺区出现爆玉米花样钙化;（２）干骺端外展、增宽,骨骺见有多囊状透光区;（３）骨干不规则增粗,骨骺和干骺被粗大的骨小梁交织为蜂房状;（４）尺－桡或胫－腓骨间膜粘连、增生和骨化;（５）并行两长管骨之一的游离侧     

Reproducibility of the pettersson scoring system. An interobserver study

By means of the Pettersson scoring system, the degree of severity of haemophilic arthropathy in 128 knee, elbow and ankle joints was estimated by 5 radiologists. Their scores varied on average by approximately 3 points. Minimal and maximal joint involvement were scored consistently; exclusion of haemophilic arthropathy was possible with the highest degree of certainty. With regard to changes of a moderate degree agreement was seldom reached. With precisely defined characteristics, a high degree of consistency between observers was evident. Interobserver variation in the scoring was more marked in the ankle joint than in the other joints. Scoring was more consistent with the more experienced observers.     

Neuropathic arthropathy of the foot with and without superimposed osteomyelitis: MR imaging characteristics

PURPOSE: To determine retrospectively the magnetic resonance (MR) findings associated with pedal neuropathic arthropathy with and without superimposed osteomyelitis and to identify any useful discriminating features. MATERIALS AND METHODS: Investigational review board approval was obtained and allowed review of records and images without informed consent. HIPAA compliance was observed. Contrast-enhanced MR images in patients with diabetic neuropathic arthropathy of the foot were examined by two reviewers in consensus. Affected joints were examined for marrow, articular, periarticular, and soft-tissue findings. Presence of superimposed osteomyelitis was documented. A subgroup that had undergone MR before infection was evaluated for comparison; chi(2) and t tests were used to evaluate the associations. RESULTS: Of 128 neuropathic joints in 63 patients (24 female, 39 male; aged 31-78 years), 43 had superimposed osteomyelitis. Effusion was common in all neuropathic joints, but thin rim enhancement was more common in noninfected joints (62% vs 21%, P < .001) and diffuse joint fluid enhancement was more common with infection (47% vs 26%, P = .052). Subluxation, bone proliferation, fragmentation, and erosion were seen in both groups, but intraarticular bodies were more common in noninfected joints (53% vs 12%, P < .001). In the periarticular soft tissues, edema, enhancement, and ulceration were common in both groups. Fluid collections in the soft tissues were more commonly associated with infected joints (95% vs 48%, P < .001) and, when present next to an infected joint, were larger than those next to noninfected neuropathic joints (2.6 cm(2) [range, 0.3-8.6 cm(2)] vs 1.6 cm(2) [range, 1.0-2.4 cm(2)]). Soft-tissue fat replacement (68% vs 36%, P = .002) and sinus tracts (84% vs 0%, P < .001) were also more common with infection. In the marrow, periarticular signal intensity abnormality was common in both groups, but the extent was greater with infection. Subchondral cysts were seen almost exclusively in noninfected joints (76% vs 2%, P < .001). Similar results were obtained in the subgroup of 21 joints (15 patients) with both pre- and postinfection MR images. CONCLUSION: Sinus tract, replacement of soft-tissue fat, fluid collection, and extensive marrow abnormality are MR imaging features indicating superimposed infection. Thin rim enhancement of effusion, presence of subchondral cysts, or intraarticular bodies indicate absence of infection.     

椎小关节病的CT诊断：附402例分析

笔者对１０１７例肩背和／或腰腿痛患者的临床、Ｘ线及ＣＴ资料进行了回顾性分析。ＣＴ显示椎小关节异常４０２例，Ｘ线显示１８３例。ＣＴ对本病的显示率比Ｘ线高１２倍。ＣＴ能有效地显示关节突增生肥大、骨赘形成、关节间隙变窄、骨性关节面改变、关节脱位及半脱位、侧隐窝或椎间孔狭窄、关节囊钙化及关节“真空”征等。后二者Ｘ线检查难以显示。ＣＴ易于显示椎小关节病及其并存症，对肩背腰腿痛患者的合理施治有重要意义。     

Calcium pyrophosphate dihydrate crystal deposition disease

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is characterized by the accumulation of pyrophosphate dihydrate crystals in articular and periarticular tissues. Various terms have been utilized to describe this arthropathy, which has led to some confusion. CPPD crystal deposition disease is among many conditions that may result in crystal deposition within cartilage. Chondrocalcinosis is a pathologic and radiographic term denoting calcification of cartilage within joints including both hyaline articular cartilage and fibrocartilage. Pseudogout is a clinical term applied to an acute inflammatory process in a joint(s) mimicking a gout attack. Pseudogout is just one of the multiple clinical presentations for CPPD crystal deposition disease. Pyrophosphate arthropathy is a term that has been used to describe the peculiar pattern of joint destruction associated with CPPD crystal deposition disease. This article reviews the protean manifestations of CPPD crystal deposition disease with emphasis on diagnostic imaging.     

Musculoskeletal manifestations of hemophilia: imaging features

The purpose of this pictorial assay is to demonstrate the imaging features of the various musculoskeletal manifestations of hemophilia, an X-linked disorder. Depending on the site of recurrent bleeding, musculoskeletal manifestation can be in the form of hemophilic arthropathy and/or soft tissue, intraosseous, or subperiosteal pseudotumors. Radiography, sonography, computed tomography, and especially magnetic resonance imaging help in the evaluation of hemophilic arthropathy and pseudotumors, providing accurate diagnosis, thus avoiding inadvertent procedures and related complications. Treatment includes replacement of clotting factors either continuously or when indicated, radionuclide or open synovectomy in cases of disabling arthropathy.     

成人强直性髋关节炎分期

目的：探讨强直性髋关节炎如何从平片上判断预后功能分期。方法：100例成人AS髋关节炎，男91例．女9例；根据法定成人年龄．本组最小19岁．只有1例71岁．平均29．9岁。临床主要表现为全身乏力，腰背和髋部疼痛．功能障碍。结果：100例成人强直性脊柱炎．其中7例行MR成像检查。均有骶髂关节和髋火节病理性征象和股骨头灶性坏死。关节间隙不同程度狭窄达95％、股骨头关节边缘滑膜骨化发生率达84％。垂线征是一种骨化线，它从股骨头内下缘向外下至股骨颔，发生牢为69％。100例成人强直性脊柱炎髋臼窝狭窄的发生率高达75％。耻骨联合边缘硬化或吸收和坐骨结节大收肌腱附着点骨化发生率为53％。根据上述综合征象．提出髋关节炎分为4期。Ⅰ期：两侧髋关节变化轻微；Ⅱ期：髋关节狭窄伴随关节周围有明确异常征象；Ⅲ期：髋荚节严蕈狭窄伴随关节周围的严重异常；Ⅳ期：髋关节韧带骨化融合或骨性融合。结论：以髋关节软骨坏死的程度可将强直性髋关节炎分为4期．体现了预后功能的判断。