骶骨衰竭骨折MRI研究

目的探讨骶骨衰竭骨折的MR I表现特征及其诊断价值。方法21例病人,女19例,男2例,平均年龄72.4岁。所有病人均有骨质疏松,其中7例为盆腔肿瘤放疗后发病。MR I检查使用矢状位、横轴位和冠状位SE T1W I、FSE T2W I和脂肪抑制FSET2W I。其中14例同时行SE T1W I增强扫描。所有病人均同时行X线平片、CT平扫检查,其中14例行同位素扫描以证实诊断。结果21例共发生37侧骶骨耳部骨折,其中16例(76.2%)为双侧骨折,5例(23.8%)为单侧骨折。37侧骨折中,32侧(86.5%)显示“蛇形”低信号骨折线。所有病例均显示片状或三角形骨折周围水肿区呈长T1长T2异常信号。14例增强扫描,骨折线均无强化,水肿区呈不均匀强化。3例合并其他部位多发性不全骨折。结论MR I诊断骶骨衰竭骨折具有特征性,可显示骨折线及骨折周围水肿区。     

骨盆衰竭骨折的影像学表现分析

目的 :探讨骨盆衰竭骨折的影像学表现特征及其诊断价值。方法 :回顾性分析27例经影像学检查并随访证实的骨盆衰竭骨折的影像学征象,27例均行骨盆正侧位X线检查,其中23例同时行CT检查,18例行MRI检查,15例行SPECT-CT检查。结果:27例中骨折发生于骶骨23例,其中单侧6例,双侧17例;髂骨9例,其中单侧5例,双侧4例;耻骨支8例,其中单侧6例,双侧2例。3例X线显示阳性征象,表现为与相邻关节平行的骨折线影或线样硬化影,与骨小梁垂直。23例CT显示双侧骶骨耳状面、耻骨支及髂骨翼明显骨折线影或线样高密度硬化影,骨折线或硬化影平行于相邻关节面,23例均可见明显骨质疏松,周围软组织稍显肿胀。18例MRI示骶骨、耻骨及髂骨可见线状长T1、短T2信号,边界清晰或不清,周围可见大片状长T1长T2水肿信号影。15例SPECT-CT均显示为典型的H型或纺锤型放射性核素异常浓聚。结论:X线对骨盆衰竭骨折的敏感性不及CT、MRI和SPECT-CT,特别是SPECT-CT敏感性更高,能够早期诊断衰竭骨折,但其特异性低,因此,临床诊断时需结合各种影像学检查及临床病史,以提高诊断率。     

骶骨骨折合并男性勃起功能障碍

骶骨骨折多见于高能量损伤 ,常合并鞍区麻木、下肢疼痛及大小便潴留或失禁。 1997年 2月至今 ,笔者收治骶骨骨折合并不同程度的勃起功能障碍 6例。现报告如下。临　床　资　料6例均为 2 7～ 41岁男性 ,砸伤 3例 ,交通伤 2例 ,坠落伤 1例。按Ｄｅｎｉｓ分型 ,Ⅰ区 1例 ,Ⅱ区 2例 ,Ⅲ区 3例。除 2例伤后 7个月及 1例伤后始终无勃起 2年性功能丧失求治外 ,余均为首诊。均诉伤处肿痛 ,不能坐立及负重。追问病史 ,诉会阴区及阴茎麻胀不适 ,夜间阴茎勃起消失。体检 :提睾反射双侧消失 3例 ,2例右侧消失 ,左侧减弱 ,1例仅右侧消失。随诊发现阴茎对…     

骶骨骨折合并骶神经损伤10例

我院 1991年 1月～ 1998年 1月共收治骶骨骨折合并骶神经损伤 10例 ,疗效满意。报告如下。临床资料　 ( 1)一般资料 :本组男 8例 ,女 2例 ;年龄 18～ 5 2岁 ,平均 42 .3岁。致伤原因 :车祸伤 3例 ,塌方压伤 2例 ,吊车重物砸伤 2例 ,高处坠落伤 2例 ,铲车铲伤 1例。受伤至入院时间 1ｈ～ 9ｄ。闭合骨折 9例 ,开放骨折 1例。合并伤 :合并单侧耻骨上下支骨折 2例 ,双侧耻骨上下支骨折 3例 ,Ｔ12 压缩性骨折 1例 ,脾破裂 1例 ,肾挫伤 2例。骨折类型 :ＣＴ及Ｘ线片示横形骨折 6例 ,其中Ｓ1骶孔平面 1例 ,Ｓ2 骶孔平面 1例 ,Ｓ3 、Ｓ4 骶孔平面各 …     

骶骨骨折的X线观察

骨盆外伤时骨发生骨折的部位是坐骨，耻骨和髂骨，而Harris代报告骶骨骨折亦可高达72％（1），由于患者当时病情多较严重，摄片前不能很好地进行肠道清洁准备，加上摄片时病人因为疼痛影响骨盆位置不易摆正……许多因素影响了骶骨骨折的X线观察，因此Harris氏报道骶骨骨折漏诊率竞高达61％（1）。     

非特异性肉芽肿性乳腺炎的影像学表现

目的 :探讨非特异性肉芽肿性乳腺炎(IGM)的X线、CT及MRI特征。方法 :回顾性分析53例经手术病理证实的IGM的X线、CT及MRI资料。结果:X线示15例病灶呈等或稍高于正常腺体密度肿块影;5例呈局限性致密影或结构扭曲;9例因腺体致密显示不清。CT示14例呈等或稍高于正常腺体密度肿块影,增强扫描明显强化;2例呈囊性改变,增强扫描边缘强化。MRI示T1WI呈等或稍高信号,T2WI呈不等高信号,增强扫描病变片状强化,信号高于正常腺体,部分病变伴脓肿形成,部分伴环形强化结节影,TIC呈多样性。X线、CT及MRI可见部分病例伴乳头内陷、局部皮肤增厚。结论:IGM乳腺X线表现特异性差,CT与MRI表现具有一定特异性,影像结合临床有助于准确诊断。     

骶骨骨折的诊断和治疗进展

有关骶骨骨折的描述最早可一直追溯至公元7世纪。骶骨骨折发病率不高，但在临床诊治中很容易漏诊，近年来国内文献中专文报道较少见。笔者就近年来骶骨骨折及骨折合并神经损伤的诊断及治疗研究进展作一综述。     

骶骨肿瘤的影像学表现

骶骨由骨、软骨、骨髓、脊膜、神经和脊索残余等组成.骶骨的良、恶性肿瘤均起源于上述组织结构.原发性骶骨肿瘤是较少见的肿瘤,其中最常见的是脊索瘤和巨细胞瘤,其它原发性骶骨肿瘤均少见,而继发性骶骨恶性肿瘤(骨转移瘤)较常见.     

宫颈癌放疗后骶骨衰竭骨折的18F-FDG PET/CT图像特征分析

目的 探讨宫颈癌放疗后骶骨衰竭骨折(sacral insufficiency fracture, SIF)的¹⁸F-FDG PET/CT图像特征。方法 选取行¹⁸F-FDG PET/CT检查诊断为SIF并经随访证实的10例宫颈癌放疗后患者的图像资料。结果 10例患者中SIF发生于骶骨左侧6例、骶骨右侧2例,骶骨双侧2例。骶骨受累范围为S1-3椎体。病灶均位于骶髂关节面下,与骶髂关节平行分布,呈不均匀斑片样或片条样¹⁸F-FDG摄取增高,边界不清,一般不超越骶髂关节,SUVmax为2.5～5.5,相应CT显示局部骨质密度不均匀增高,部分骨皮质局部骨质不连续,见低密度骨折线。10例患者均未经任何肿瘤相关治疗,在12～36个月的临床随访过程中疼痛情况明显缓解。结论 宫颈癌放疗后SIF在PET/CT图像上也表现为¹⁸F-FDG摄取增加,可能会被误诊为转移性疾病,熟悉病变的位置、形态和代谢特征,有助于防止误诊导致的不适当的治疗以及不必要的骨活检。     

Imaging of sacral fractures

The article discusses traumatic, insufficiency and pathological sacral fractures. Special attention is paid to the biomechanics and subsequent classification of traumatic sacral fractures.     

Imaging of sacral tumours

All components of the sacrum (bone, cartilage, bone marrow, meninges, nerves, notochord remnants, etc.) can give rise to benign or malignant tumours. Bone metastases and intraosseous sites of haematological malignancies, lymphoma and multiple myeloma are the most frequent aetiologies, while primary bone tumours and meningeal or nerve tumours are less common. Some histological types have a predilection for the sacrum, especially chordoma and giant cell tumour. Clinical signs are usually minor, and sacral tumours are often discovered in the context of nerve root or pelvic organ compression. The roles of conventional radiology, CT and MRI are described and compared with the histological features of the main tumours. The impact of imaging on treatment decisions and follow-up is also reviewed.     

Scintigraphic diagnosis of sacral fractures

The H- or butterfly-pattern of uptake in the sacrum on Tc-99m-methylene diphosphonate bone scintigraphy is typical of fractures of the body of the sacrum that involve the sacral alae. This report describes four patients with a focal linear or curvilinear pattern of uptake in sacral fractures without alae involvement. This pattern differs from that associated with metastases in the sacrum, which typically has a random pattern. Recognition of this scintigraphic linear dot pattern of uptake in horizontal fractures in the inferior body of the sacrum is useful for detecting fractures without alae involvement that are not readily apparent on radiographs.     

Percutaneous sacroplasty for the treatment of sacral insufficiency fractures

OBJECTIVE: The purpose of this article is to illustrate the effectiveness and utility of percutaneous sacroplasty in the treatment of sacral insufficiency fractures. We also outline the technical considerations in performing the procedure. CONCLUSION: Percutaneous sacroplasty is an effective treatment for sacral insufficiency fractures. Most patients experience significant relief within the first 48 hr.     

CT-guided sacroplasty for the treatment of sacral insufficiency fractures

AIM: To describe the clinical presentation, procedure and outcome in patients treated with computed tomography (CT)-guided sacroplasty as a treatment for sacral insufficiency fractures. MATERIALS AND METHODS: Three patients (mean age 80 years, range 75-87 years) were treated with CT-guided sacroplasty. The mean pre-procedure visual analogue score (VAS) for pain was 8 (range 7-9) with a mean symptom duration of 8 months (range 2.5-18). The procedure was performed under CT guidance with needles being placed along the fracture lines from a posterior approach. Polymethylmethacrylate (PMMA) cement was introduced in 0.2 ml aliquots after cement temperature reduction. Cement injection was monitored by four-section block axial acquisition to assess potential cement migration. RESULTS: All three procedures were performed without significant complication. One patient developed a tiny asymptomatic cement leak into the S1 foramen. The mean volume of cement injected into a unilateral sacral fracture was 4 ml. All patients tolerated the procedure well under intravenous sedation. The mean VAS score post-procedure was 2. Continued symptomatic relief was seen at 6 weeks and 3 months. CONCLUSION: CT-guided sacroplasty represents an alternative treatment for sacral insufficiency fractures that are resistant to conservative treatment. The symptomatic relief the procedure produces seems to be excellent both in this small series and in described cases in the literature.     

骶骨骨折的分型及手术治疗

骶骨是人体负重线上的轴心,与周围腰椎髂骨构成复杂韧带骨结构复合体。高能量损伤多见,应力骨折及骨质疏松性骨折等也有报道,骶骨骨折的分型从最早的Denis分型,侧重神经损害的Roy-Camille分型,侧重腰椎骶骨稳定性的ISSLE分型,侧重骨盆环稳定性的AO分型以及较新的引入韧带评价的LSICS评分,反映了临床医生对骶骨及其周围损伤的认识不断深化。骶骨骨折治疗重点是重建骨盆环稳定、重建脊柱骨盆稳定以及神经损伤治疗,微创化及坚强固定是主要的发展方向。同时本文也介绍了笔者单位对骶骨骨折的治疗情况。