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醫(yī)學免費論文:臀肌化膿性感染的MRI診斷及其臨床意義
【摘要】 目的 探討臀肌化膿性感染的MRI診斷及其臨床意義。方法 回顧性分析經(jīng)手術或穿刺活檢證實的12例臀肌化膿性感染的臨床及MRI資料。結(jié)果 12例罹患臀肌彌漫性腫大，病變順肌肉長軸發(fā)展為主，累及臀肌全部或大部，基本征象為肌肉水腫、壞死及膿腫形成。8例亞急性或慢性感染出現(xiàn)纖維肉芽組織增生，不同病變MRI信號各具特點。5例表現(xiàn)為化膿性肌炎，炎性水腫較為廣泛；7例形成典型肌肉膿腫，膿腔較大或以膿腔為主。5例化膿性肌炎應用抗生素治療，7例肌肉膿腫行穿刺或切開引流術，均獲治愈。結(jié)論 MRI能夠反映臀肌化膿性感染各個時期的病理特征及病變范圍，并可正確診斷，對臨床治療具有重要指導意義。
【關鍵詞】 臀��； 化膿性感染； 磁共振成像
MRI diagnosis of the pyogenic infection in gluteus muscles and its clinical significance GUO Jingtao^,LU Yi,SONG Guoyong,et al.^Department of Radiology,the 260th Hospital of PLA,Shijiazhuang 050041,China
【Abstract】 Objective To explore the MRI diagnosis of the pyogenic infection in gluteus muscles and its clinical significance. Methods The clinical and MRI data of 12 cases with the pyogenic infection in gluteus muscles proved by operation or biopsy were retrospectively analysed. Results The MRI of the 12 cases displayed that the infective gluteus muscles were swelling diffusely and the infections developed along the long axis of the muscles and most or all gluteus muscles were involved in. The basic characteristics were edema and necrosis of the muscles and abscess. The fibrogranulation tissue hyperblastosis occurred in 8 patients with subacute or chronic infection.The different affections had different features. Suppurative myositis was displayed and had been cured by antibiotics in 5 patients. Typical abscess in muscle was developed and had been cured by paracentesis or incision and drainage in 7 patients. Conclusion The pathological characters of the every stage and extent of the pyogenic infection in gluteus muscles can be displayed by MRI. MRI can be used in diagnosing the pyogenic infection in gluteus muscles accurately and has important guiding meaning for clinical treatments醫(yī).學.全.在.線52667788.cn.
【Key words】 Gluteus muscles；Pyogenic infection；Magnetic resonance imaging
臀肌化膿性感染位置深在，病初癥狀多不明顯，以至感染進入亞急性或慢性階段，臨床診治存在一定難度，有效的影像學檢查非常必要。國內(nèi)有關臨床報道眾多，而影像學表現(xiàn)論述較少［1，2］。本文回顧性分析經(jīng)手術或穿刺活檢證實的12例臀肌化膿性感染的臨床及MRI資料，并與病理結(jié)果對照，探討臀肌化膿性感染的MRI特征及臨床診斷意義。
1 資料與方法
1.1 一般資料 收集我院2004年2月～2008年8月經(jīng)手術或穿刺活檢證實的臀肌化膿性感染患者12例，男7例，女5例；年齡3～65歲，平均17歲。病程2周～3年，平均3個月。有臀肌注射史7例，臀部外傷及癤腫史各1例，前列腺膿腫史1例，病因不明2例。6例間歇低熱，3例寒戰(zhàn)高熱，2例有一過性發(fā)熱，1例無明確發(fā)熱史。所有患者表現(xiàn)為不同程度的臀部壓痛和痛性跛行，7例臀深部觸及包塊。9例白細胞總數(shù)升高，3例在正常范圍內(nèi)。細菌培養(yǎng)發(fā)現(xiàn)金黃色葡萄球菌6例，溶血性鏈球菌2例，白色葡萄球菌、大腸桿菌各1例，無細菌生長2例。
1.2 檢查方法 采用安科OpenMark Ⅲ 0.3 T永磁型磁共振成像儀，體部正交線圈。以橫斷面為主，輔以冠狀面或矢狀面。常規(guī)序列為SE T1WI(TR 340 ms，TE 16 ms)、FSE T2WI(TR 3 000 ms，TE 87 ms)，并加掃STIR(TR 1 600 ms，TE 30 ms,TI 90 ms)。層厚5～7 mm，層間距1 mm，F(xiàn)OV 35 cm×35 cm，激勵次數(shù)2～4次，矩陣(180～360)×(256～512)。
