标题：单侧股骨头缺血坏死患者双侧坐骨股骨间隙的MRI表现及其与继发 IFI的相关性

      作者：许林森，祝华强，黄文健，黎洪慨    中国科学院大学深圳医院(光明)医学影像科，广东 深圳 518106

      卷次： 2023年34卷2期

      【摘要】 目的 探究单侧股骨头缺血坏死(ONFH)患者双侧坐骨股骨间隙(IFS)的磁共振(MRI)表现及其与继发坐骨股骨撞击综合征(IFI)的相关性。方法 回顾性分析2016年1月至2021年6月中国科学院大学深圳医院收治的108例单侧ONFH患者的临床资料，将其设置为研究组，其中国际骨循环学会(ARCO) Ⅰ期19 例、Ⅱ期32 例、Ⅲ期33例、Ⅳ期 24例。选择同期体检且髋关节结构正常无病变的50例健康者作为对照组。比较不同ARCO分期单侧ONFH患者及对照组的坐骨股骨间隙(IFS)、股方肌间隙(QFS)和颈干角(CCD)。所有图像分析及测量均分别由两位从事骨骼肌肉系统放射诊断的高年资医师利用SIEMENS syngoMMWPVE40E工作站进行操作。结果 ARCOⅢ、Ⅳ期患者健侧的 IFS、QFS间距分别为(19.75±7.96) mm、(14.92±6.76) mm、(23.18±6.84) mm、(17.10±7.31) mm，明显小于患侧的(24.51±6.28) mm、(19.65±5.30)mm，(28.58±5.28) mm、(22.89±6.25) mm，差异均具有统计学意义(P<0.05)；ARCO Ⅲ、Ⅳ期患者健侧的CCD数值分别为(135.78±5.71)°、(137.65±7.64)°，明显高于患侧的(129.65±2.43)°、(132.79±6.08)°，差异均具有统计学意义(P<0.05)；研究组患者健侧的 IFS值和QFS分别为(21.14±7.08) mm、(12.34±6.83) mm，明显小于对照组的(26.07±6.13) mm、(21.89±7.09) mm及研究组患侧的(25.19±5.51) mm、(19.53±5.32) mm，差异均有统计学意义(P<0.05)；研究组患者健侧CCD为(137.78±3.89)°，明显大于对照组的(130.87±4.65)°及研究组的患侧(132.37±7.04)°，差异均有统计学意义(P<0.05)。结论 ARCOⅢ、Ⅳ期的单侧ONFH患者由于长期骨盆向健侧偏斜的跛行，将出现健侧股骨头髋关节的 IFS、QFS降低，最终出现 IFI 可能性增大。
      【关键词】 股骨头缺血坏死；坐骨股骨间隙；坐骨股骨撞击综合征；磁共振；相关性
      【中图分类号】 R681.8 【文献标识码】 A 【文章编号】 1003—6350（2023）02—0244—04

MRI findings of bilateral ischiofemoral space in patients with unilateral osteonecrosis of the femoral head andtheir correlation with secondary ischiofemoral impingement.
XU Lin-sen, ZHU Hua-qiang, HUANG Wen-jian, LIHong-kai. Department of Medical Imaging, Shenzhen Hospital (Guangming) of University of Chinese Academy of Sciences,Shenzhen 518106, Guangdong, CHINA
【Abstract】 Objective To investigate the magnetic resonance imaging (MRI) findings of bilateral ischiofemoralspace (IFS) in patients with unilateral osteonecrosis of the femoral head (ONFH) and its correlation with secondary is-chiofemoral impingement syndrome (IFI). Methods The clinical data of 108 patients with unilateral ONFH admittedto Shenzhen Hospital of University of Chinese Academy of Sciences from January 2016 to June 2021 were retrospective-ly analyzed. The patients were assigned to the study group, including 19 with stage Ⅰ, 32 with Arco stage Ⅱ, 33 withArco stage Ⅲ, and 24 with Arco stage Ⅳ according to the International Society of bone circulation (ARCO). Fiftyhealthy people who had normal hip joint structure and no disease were selected as the control group. The IFS, quadratusfemoris space (QFS), and cervical trunk angle (CCD) of unilateral ONFH patients with different Arco stages and con-trols were compared. All image analysis and measurement were performed by two senior physicians engaged in radiationdiagnosis of skeletal muscle system using Siemens syngoMMWP VE40E workstation. Results The distances of IFS andQFS in the healthy side of the patients with ARCO stage Ⅲ and Ⅳ were (19.75±7.96) mm, (14.92±6.76) mm, (23.18±6.84) mm, and (17.10±7.31) mm, respectively, which were significantly smaller than (24.51±6.28) mm, (19.65±5.30) mm,(28.58±5.28) mm, and (22.89±6.25) mm in the affected side (P<0.05). The CCD values of the healthy side of the patientswith ARCO stage Ⅲ and Ⅳ were (135.78±5.71)°, (137.65±7.64)°, which were significantly higher than (129.65±2.43)°,(132.79±6.08)° of the affected side (P<0.05). The IFS value and QFS of the healthy side in the study group were (21.14±7.08) mm and (12.34±6.83) mm, respectively, which were significantly smaller than (26.07±6.13) mm and (21.89±7.09) mmof the control group, and (25.19±5.51) mm and (19.53±5.32) mm of the affected side in the study group (P<0.05). TheCCD of the healthy side in the study group was (137.78±3.89)°, which was significantly larger than (130.87±4.65)° inthe control group and (132.37±7.04)° in the study group (P<0.05). Conclusion In patients with unilateral ONFH in AR-CO stage Ⅲ and Ⅳ, due to long-term claudication of the pelvis to the healthy side, the IFS and QFS of the femoral headand hip joint on the healthy side will decrease, and the possibility of IFI will increase.
      【Key words】 Osteonecrosis of the femoral head (ONFH); Ischiofemoral space (IFS); Ischiofemoral impingement(IFI) syndrome; Magnetic resonance imaging; Correlation