中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2015年
20期
2481-2484
,共4页
倪广晓%韩娟%赵巧艳%岳崴%姜建勇%牛彦平
倪廣曉%韓娟%趙巧豔%嶽崴%薑建勇%牛彥平
예엄효%한연%조교염%악외%강건용%우언평
骨髓水肿%踝关节%疼痛%磁共振成像
骨髓水腫%踝關節%疼痛%磁共振成像
골수수종%과관절%동통%자공진성상
Bone marrow edema%Ankle joint%Pain%Magnetic resonance imaging
目的:分析踝关节骨髓水肿综合征( BMES)患者的临床表现和MRI成像特点,为临床诊治提供依据。方法回顾性分析2011年4月—2012年5月河北医科大学第二医院确诊的67例踝关节BMES患者的临床资料,包括人口统计数据、药物和手术治疗史、预后及门诊随访资料。门诊随访内容:记录视觉模拟评分( VAS)、美国足踝外科协会踝-后足评分系统( AOFAS)评分,应用3.0 T磁共振成像仪进行扫描,包括T1和T2加权像,并记录距骨骨髓水肿面积。结果患者均接受了非手术治疗,29例患者接受了口服非甾体类抗炎药、物理因子治疗,保护性负重;18例患者接受了中药熏蒸、关节松动术、带或不带支具的部分负重;20例患者先后接受上述两种治疗。经过治疗后,61例患者的症状完全消失,保守治疗的平均时间为2.4个月。患者随访不同时间点VAS、AOFAS评分和距骨骨髓水肿面积比较,差异均有统计学意义( P<0.05)。患者AOFAS评分优良率为92.5%(62/67)。患者初诊MRI表现:T2加权像为弥漫性、不规则增强信号,T1加权像为边界不清的低信号区。63例患者MRI水肿消退与临床症状的改善一致。踝关节BMES受累骨骼2~6块。结论踝关节BMES MRI成像特点为T1加权像变量区域低信号,T2加权像表现为不规则的弥漫性高信号。患者MRI显示距骨均有骨髓水肿表现,受累踝关节骨骼至少为2块。此外,多数患者MRI改变与临床症状一致。
目的:分析踝關節骨髓水腫綜閤徵( BMES)患者的臨床錶現和MRI成像特點,為臨床診治提供依據。方法迴顧性分析2011年4月—2012年5月河北醫科大學第二醫院確診的67例踝關節BMES患者的臨床資料,包括人口統計數據、藥物和手術治療史、預後及門診隨訪資料。門診隨訪內容:記錄視覺模擬評分( VAS)、美國足踝外科協會踝-後足評分繫統( AOFAS)評分,應用3.0 T磁共振成像儀進行掃描,包括T1和T2加權像,併記錄距骨骨髓水腫麵積。結果患者均接受瞭非手術治療,29例患者接受瞭口服非甾體類抗炎藥、物理因子治療,保護性負重;18例患者接受瞭中藥熏蒸、關節鬆動術、帶或不帶支具的部分負重;20例患者先後接受上述兩種治療。經過治療後,61例患者的癥狀完全消失,保守治療的平均時間為2.4箇月。患者隨訪不同時間點VAS、AOFAS評分和距骨骨髓水腫麵積比較,差異均有統計學意義( P<0.05)。患者AOFAS評分優良率為92.5%(62/67)。患者初診MRI錶現:T2加權像為瀰漫性、不規則增彊信號,T1加權像為邊界不清的低信號區。63例患者MRI水腫消退與臨床癥狀的改善一緻。踝關節BMES受纍骨骼2~6塊。結論踝關節BMES MRI成像特點為T1加權像變量區域低信號,T2加權像錶現為不規則的瀰漫性高信號。患者MRI顯示距骨均有骨髓水腫錶現,受纍踝關節骨骼至少為2塊。此外,多數患者MRI改變與臨床癥狀一緻。
목적:분석과관절골수수종종합정( BMES)환자적림상표현화MRI성상특점,위림상진치제공의거。방법회고성분석2011년4월—2012년5월하북의과대학제이의원학진적67례과관절BMES환자적림상자료,포괄인구통계수거、약물화수술치료사、예후급문진수방자료。문진수방내용:기록시각모의평분( VAS)、미국족과외과협회과-후족평분계통( AOFAS)평분,응용3.0 T자공진성상의진행소묘,포괄T1화T2가권상,병기록거골골수수종면적。결과환자균접수료비수술치료,29례환자접수료구복비치체류항염약、물리인자치료,보호성부중;18례환자접수료중약훈증、관절송동술、대혹불대지구적부분부중;20례환자선후접수상술량충치료。경과치료후,61례환자적증상완전소실,보수치료적평균시간위2.4개월。환자수방불동시간점VAS、AOFAS평분화거골골수수종면적비교,차이균유통계학의의( P<0.05)。환자AOFAS평분우량솔위92.5%(62/67)。환자초진MRI표현:T2가권상위미만성、불규칙증강신호,T1가권상위변계불청적저신호구。63례환자MRI수종소퇴여림상증상적개선일치。과관절BMES수루골격2~6괴。결론과관절BMES MRI성상특점위T1가권상변량구역저신호,T2가권상표현위불규칙적미만성고신호。환자MRI현시거골균유골수수종표현,수루과관절골격지소위2괴。차외,다수환자MRI개변여림상증상일치。
Objective To analyze the clinical manifestation and the characteristics of MRI of patients with bone marrow edema syndrome(BMES)in order to provide references for clinical diagnosis and treatment. Methods We made a retrospective analysis of the clinical data of 67 patients who were diagnosed with BMES in ankle joint in the Second Hospital of Hebei Medical University from April 2011 to May 2012. The data included demographic data,medication,history of surgery and treatment,prognosis and follow-up data. The subjects were asked to make regular follow-up visits,during which VAS and AOFAS scores were evaluated,3. 0 T MRI scanning was conducted,including T1WI and T2WI,and the area of marrow edema in ankle bone was also recorded. Results The patients all received nonsurgical treatment. There were 29 patients who took oral non-steroid anti-inflammatory agents,physical agent therapy and protective load-bearing therapy,18 patients who received TCM fumigation,joint mobilization and partial load-bearing with or without brace,and 20 patients who received both of the two regimens. After treatment,61 subjects had their symptoms disappear,and the average length of conservative treatment was 2. 4 months. The patients had different ( P <0. 05 ) VAS scores, AOFAS scores and bone marrow edema areas at different time points. The proportion of patients who had good AOFAS score was 92. 5%(62/67). The first MRI showed T2MI images with diffusive and irregular enhancement signal and T1MI images with obscure boundary and low signals. There were 63 patients whose alleviation of clinical symptoms was consistent with MRI results. The number of bones influenced by BMES was 2 - 6. Conclusion MRI of BMES in ankle joint showed T2MI images with diffusive and irregular enhancement signal and T1MI images with low signals in variable area. By MRI,all subjects were noted with BMES in ankle joint,and the minimum number of influenced bones was 2. Besides,most patients found their MRI changes consistent with the changes of clinical symptoms.