目的:分析MRI对成人股骨头坏死早期诊断的价值.方法:选取2019年4月—2023年4月北京市通州区中西医结合医院收治的20例早期成人股骨头坏死患者,分别采用CT和MRI检查,以手术病理结果为金标准,比较两者对成人股骨头坏死不同分期及典型征象的检出情况,分析典型病例影像学表现.结果:病理结果显示,股骨头坏死Ⅰ期有8例、Ⅱ期6例、Ⅲ期4例、Ⅳ期2例,MRI检查股骨头坏死不同分期的总检出率95.00%明显高于CT检查的70.00%(P＜0.05);MRI检查骨小梁结构模糊、骨髓水肿检出率均明显高于CT检查(P＜0.05),两者线样征、单一囊变检出率差异无统计学意义(P＞0.05).结论:采用MRI检查在成人股骨头坏死早期诊断中能够提升诊断的准确性,可提高成人股骨头坏死影像学典型征象的检出率,具有较高的应用价值.

目的 探讨腰椎后路融合术对邻近椎体局部体积骨密度(volumetric bone mineraldensity,vBMD)的影响,以及术后vB-MD变化的影响因素.方法 回顾性分析180 例行腰椎后路融合手术的患者术前及术后CT资料.分析手术椎体上 1、2 个节段(UIV+1、UIV+2)及下1 个节段(LIV+1)椎体vBMD的变化,并采用线性回归模型分析vBMD变化的影响因素.结果 研究对象平均年龄为(62.4±6.7)岁.与术前相比,患者术后UIV+1、UIV+2 和LIV+1 的vBMD均显著下降,差异有统计学意义(P<0.05).线性回归分析显示,手术前硬膜外类固醇注射、手术和第2 次CT时间的间隔及腰椎后路融合术是vBMD变化的独立因素.结论 腰椎后路融合术对邻近节段局部vBMDs有负面影响.

[Objective]To evaluate the bone mineral density (BMD) and bone strength of femoral bone in patients with type 1 diabetes mellitus by quantitative CT, and the relationship with insulin-like growth factor-1 (IGF-1).[Methods]Twenty-five patients with type 1 diabetes mellitus in our hospital were selected as observation group, and 25 healthy subjects in the same period of time in our hospital were selected as control group.Through the three-dimensional quantitative CT, volumetric bone mineral density (vBMD) and bone strength , serum IGF-1, bone alkaline phosphatase (B-ALP), osteocalcin (sOC) and procollagen amino terminal peptide (P I NP) at different parts of femoral bone were calculated ,and the correlation between bone mineral density and bone strength of femoral bone and IGF-1 of type I diabetes mellitus patients were analyzed.[Results]Compared with the control group, the femoral neck cortex vBMD of the observation group was significantly reduced [(582.5 ± 27.7) mg/cm3 vs (558.1± 31.9) mg/cm3,P<0.05];The total vBMD, cortical thickness and cortical cross-sectional area were significantly lower [(258.4 ± 42.9) mg/cm3 vs(223.7± 27.3)mg/cm3;(3.3 ± 0.7)mm vs(2.8 ± 0.5)mm;(5.3 ± 1.2)cm2 vs (4.3 ± 0.5)cm2;mean P<0.01].Compared with the control group, the BR of the observation group was significantly increased[(10.8 ±1.8) vs(12.9±1.9),P<0.01];The serum levels of B-ALP, sOC, P I and NP in the observation group and the control group had no significant difference (P>0.05).There was a significant positive correlation between serum IGF-1 and total vBMD of femoral neck in patients with type 1 diabetes mellitus (r=0.48;P<0.05).[Conclusion]Quantitative CT revealed that vBMD, cortical cross-sectional area and cortical thickness were lower in patients with type 1 diabetes.Serum IGF-1 level can significantly affect the total vBMD of femoral neck in patients with type 1 diabetes mellitus.