CAJ | 학술논문

目的探讨MRI在不同时期股骨头缺血坏死（FHN）的表现及其在分期中的作用。方法观察13髋FHN患者术前股骨头外形、坏死区和关节软骨的MRI表现并进行相应分为四期。将13例股骨头置换术下的股骨头标本在股骨头最大横断面切割成5mm薄片，结合MRI图像在标本切片上坏死区多点取材进行病理学观察。结果13髋中，6例股骨头外形正常且关节软骨完整，其中2髋坏死区呈单纯脂肪样信号（Ⅰ期），病理为骨小梁和骨髓坏死；4髋坏死区呈脂肪肉芽组织样混合信号（Ⅱ期），病理上为骨小梁和骨髓坏死伴有纤维肉芽组织。7髋股骨头塌陷，坏死区均呈脂肪肉芽组织样混合信号，病理上为骨小梁和骨髓坏死伴有大量纤维肉芽组织，其中2髋关节软骨未见碎裂（Ⅲ期），5髋合并关节软骨碎裂（Ⅳ期）。结论不同时期股骨头坏死的MRI表现不同，MRI分期可反映FHN病理进程，尤其在股骨头塌陷前期。
목적탐토MRI재불동시기고골두결혈배사（FHN）적표현급기재분기중적작용。방법관찰13관FHN환자술전고골두외형、배사구화관절연골적MRI표현병진행상응분위사기。장13례고골두치환술하적고골두표본재고골두최대횡단면절할성5mm박편，결합MRI도상재표본절편상배사구다점취재진행병이학관찰。결과13관중，6례고골두외형정상차관절연골완정，기중2관배사구정단순지방양신호（Ⅰ기），병리위골소량화골수배사；4관배사구정지방육아조직양혼합신호（Ⅱ기），병리상위골소량화골수배사반유섬유육아조직。7관고골두탑함，배사구균정지방육아조직양혼합신호，병리상위골소량화골수배사반유대량섬유육아조직，기중2관관절연골미견쇄렬（Ⅲ기），5관합병관절연골쇄렬（Ⅳ기）。결론불동시기고골두배사적MRI표현불동，MRI분기가반영FHN병리진정，우기재고골두탑함전기。
Objective To study the manifestations and role of MRI in the staging of femoral head necrosis(FHN).Methods MRI of 13 patients with histologically confirmed FHN was reviewed.The FHN staging of I to IV was based on MR signal intensities of necrotic areas, shape of femoral heads and articular cartilage.13 surgically removed specimens of varying stages of FHN were sawed into 5 mm thick axial slices.Multiple samples were taken from the necrotic areas for pathological examination.Results Of 13 affected femoral heads, 6 were intact with continuous articular cartilage and 7 were collapsed.The signal intensities of necrotic zones within 2 intact femoral heads were similar to fat( stage I), which corresponded to necrotic trabecular and bone marrow pathologically. The signal intensities of mixed fat and granulation in 4 intact femoral heads( stage II) corresponded to necrotic trabecular and bone marrow with inflammatory granulation tissue pathologically.The 7 collapsed femoral heads were stage III( 2 hips) necrosis with intact articular cartilage and stage IV( 5 hips) necrosis with articular cartilage disruption.The signal intensities of necrotic zones within 7 collapsed femoral heads were mixed fat and granulation, which corresponded to necrotic trabecular and bone marrow with inflammatory granulation tissue pathologically.Conclusions MRI appearance of FHN varies in different stages. MRI staging accurately reflects the pathological process, especially before the femoral heads collapse.