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医学免费论文:臀肌化脓性感染的MRI诊断及其临床意义
【摘要】 目的 探讨臀肌化脓性感染的MRI诊断及其临床意义。方法 回顾性分析经手术或穿刺活检证实的12例臀肌化脓性感染的临床及MRI资料。结果 12例罹患臀肌弥漫性肿大，病变顺肌肉长轴发展为主，累及臀肌全部或大部，基本征象为肌肉水肿、坏死及脓肿形成。8例亚急性或慢性感染出现纤维肉芽组织增生，不同病变MRI信号各具特点。5例表现为化脓性肌炎，炎性水肿较为广泛；7例形成典型肌肉脓肿，脓腔较大或以脓腔为主。5例化脓性肌炎应用抗生素治疗，7例肌肉脓肿行穿刺或切开引流术，均获治愈。结论 MRI能够反映臀肌化脓性感染各个时期的病理特征及病变范围，并可正确诊断，对临床治疗具有重要指导意义。
【关键词】 臀肌； 化脓性感染； 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医.学.全.在.线www.med126.com.
【Key words】 Gluteus muscles；Pyogenic infection；Magnetic resonance imaging
臀肌化脓性感染位置深在，病初症状多不明显，以至感染进入亚急性或慢性阶段，临床诊治存在一定难度，有效的影像学检查非常必要。国内有关临床报道众多，而影像学表现论述较少［1，2］。本文回顾性分析经手术或穿刺活检证实的12例臀肌化脓性感染的临床及MRI资料，并与病理结果对照，探讨臀肌化脓性感染的MRI特征及临床诊断意义。
1 资料与方法
1.1 一般资料 收集我院2004年2月～2008年8月经手术或穿刺活检证实的臀肌化脓性感染患者12例，男7例，女5例；年龄3～65岁，平均17岁。病程2周～3年，平均3个月。有臀肌注射史7例，臀部外伤及疖肿史各1例，前列腺脓肿史1例，病因不明2例。6例间歇低热，3例寒战高热，2例有一过性发热，1例无明确发热史。所有患者表现为不同程度的臀部压痛和痛性跛行，7例臀深部触及包块。9例白细胞总数升高，3例在正常范围内。细菌培养发现金黄色葡萄球菌6例，溶血性链球菌2例，白色葡萄球菌、大肠杆菌各1例，无细菌生长2例。
1.2 检查方法 采用安科OpenMark Ⅲ 0.3 T永磁型磁共振成像仪，体部正交线圈。以横断面为主，辅以冠状面或矢状面。常规序列为SE T1WI(TR 340 ms，TE 16 ms)、FSE T2WI(TR 3 000 ms，TE 87 ms)，并加扫STIR(TR 1 600 ms，TE 30 ms,TI 90 ms)。层厚5～7 mm，层间距1 mm，FOV 35 cm×35 cm，激励次数2～4次，矩阵(180～360)×(256～512)。
