骶髂关节病变的CT诊断

目的 阐明骶髂关节病变的ＣＴ表现。材料与方法 搜集经临床确诊或病理证实的35例骶髂关节病变者，男22例，女13例。其中强直性脊柱炎（AS）13例，类风湿性关节炎（RA）7例，化脓性骶髂关节炎2例，骶髂关节结核5例，髂骨致密性骨炎6例，创伤性关节炎2例，结果 CT表现：AS常双侧对称发病，自关节下部开始，关节面硬化与破坏，间隙狭窄或消失，骨桥形成，RA常一侧发病，易侵犯关节上壮举剖，关节面密度减低，骨质疏松，关节面下出现周围硬化的小囊状骨缺损；化脓性骶髂关节炎常单发，骨一侧发病，易侵犯关节上半部，关节面密度减低，骨质疏松，关节面下出现周围硬化的小囊状骨缺损；化脓性骶髂关节炎常单发，骨质疏松，破坏，半生，关节间隙增宽或变窄，关节囊肿胀，关节强直，周围软组织肿胀或钙化；骶髂关节结核常单侧发病，多位于关节中下部，关节面模糊，骨质破坏及死骨形成，关节间隙增宽，常伴冷脓肿和窦道形成；髂骨致密性骨炎示髂骨面硬化区，不累及关节；创伤性关节炎骨关节面增生，浓密，关节间隙狭窄，可伴骨性强直。结论 骶髂关节病变的CT表现各不相同，CT能清楚显示骶髂关节及其周围结构，是目前诊断骶髂关节病变最理想的检查手段。

CT Diagnosis of Sacro-iliac Joint Lesions

Objective To study the CT manifestations of sacro iliac joint lesions.Materials and Methods Thirty five cases, including 22 males and 13 females, with clinically or pathologically proved sacro iliac joint lesions were collected. The diseases included ankylosing spondylitis (AS, n=13), rheumatoid arthritis (RA, n=7), suppurative sacro iliac arthritis (n=2), sacro iliac joint tuberculosis (n=5), condensing ostitis (n=6) and traumatic arthritis (n=2).Results The common CT findings were as follows: (1) AS showed sclerosis and destruction of articular surface, stenosis of joint space and bone bridge formation, the lesion was usually bilateral and was initiated from the lower part of the joint. (2) RA showed osteoporosis of articular surface and subchondral small cystic bone defect with a sclerotic ring, the lesion often involved unilateral joint and was initiated from the upper part of the joint. (3) Suppurative sacro iliac arthritis, which often involved unilateral joint and presented as osteoporosis, bony destruction and hyperosteogeny, widened or narrowed articular space, arthroncus, ankylosis and soft tissue swelling or calcification. (4) Sacro iliac joint tuberculosis often involved unilateral joint. The lesion usually developed in the middle and lower part of the joint and manifested itself as blurred articular surface, bone destruction, sequester, widened joint space, cold abscess and sinus. (5) Condensing ostitis showed bone sclerosis of the sacral bony plate, the articulation was not involved. (6) Traumatic arthritis displayed hyperosteogeny, widened joint space and bony ankylosis.Conclusion Sacro iliac lesions, due to a variety of disorders, demonstrate various CT manifestations. CT scan can well display the anatomy of the sacro iliac joint as well as its neighboring structures and is the most reliable means for the diagnosis of sacro iliac joint lesions.