邻近骶髂关节原发恶性骨肿瘤跨关节侵犯的MRI研究

发布时间：2019-01-21 18:02

【摘要】：目的观察邻近骶髂关节的骨原发恶性肿瘤跨关节侵犯的MRI表现,比较不同部位、病理类型和分级的恶性骨肿瘤跨关节侵犯的发生率及侵犯方式之间是否存在差异性。方法分析2004年1月至2015年6月间经手术病理证实的93例邻近骶髂关节的髂骨(69例)和骶骨(24例)原发恶性骨肿瘤患者的临床及MRI资料,男60例,女33例,年龄4~74岁,平均32岁,包括普通型骨肉瘤29例,尤文肉瘤16例,中央型软骨肉瘤35例,脊索瘤13例。按病理恶性程度分为恶性程度较高肿瘤组和恶性程度较低肿瘤组。跨骶髂关节侵犯分为经韧带连结、经关节软骨和经关节周围三种方式,多种方式并存出现者按每种方式分别计数1次。数据处理采用SPSS 17.0统计软件进行统计学分析。结果邻近骶髂关节的骨原发恶性肿瘤跨骶髂关节侵犯27例,包括骨肉瘤15例(51.7%),尤文肉瘤7例(43.8%),软骨肉瘤4例(11.4%)和脊索瘤1例(7.7%)。髂骨和骶骨原发恶性骨肿瘤跨关节侵犯发生率之间的差异无统计学意义(χ~2值=1.06,P0.05)。恶性程度较高肿瘤组和恶性程度较低肿瘤组间跨关节侵犯的差异具有统计学意义(χ~2值=16.68,P0.01)。27例肿瘤经韧带连结25次、经关节软骨13次和经关节周围5次方式跨骶髂关节侵犯,此三种侵犯方式的几率之间差异均具有统计学意义(P0.05),恶性程度较高肿瘤组与恶性程度较低肿瘤组间的三种方式跨关节侵犯的几率差异均无统计学意义(P0.05)。结论 MRI对显示邻近骶髂关节的骨肿瘤跨关节侵犯具有非常高的敏感性。邻近骶髂关节的髂骨和骶骨原发恶性骨肿瘤跨骶髂关节侵犯发生率无明显差异,普通型骨肉瘤和尤文肉瘤跨骶髂关节侵犯率明显高于恶性程度较低的中央型软骨肉瘤和脊索瘤。骨肿瘤多经韧带连结跨关节侵犯,其跨关节侵犯方式与肿瘤恶性程度无关。
[Abstract]:Objective to observe the MRI features of transarticular involvement of primary malignant tumors of bone adjacent to sacroiliac joint and to compare the incidence and mode of transarticular invasion in different sites, pathological types and grades of malignant bone tumors. Methods the clinical and MRI data of 93 patients with primary malignant bone tumor of sacroiliac joint (69 cases) and sacrum (24 cases) confirmed by surgery and pathology between January 2004 and June 2015 were analyzed. There were 60 males and 33 females aged 4 to 74 years. The mean age was 32 years, including 29 cases of common osteosarcoma, 16 cases of Ewing's sarcoma, 35 cases of central chondrosarcoma and 13 cases of chordoma. According to the degree of pathological malignancy, it was divided into higher malignant degree group and lower malignant degree group. Transsacroiliac joint invasion was divided into three ways: ligamentous junction, articular cartilage and periarticular involvement. SPSS 17.0 statistical software was used to analyze the data. Results there were 27 cases of transsacroiliac joint involvement of primary malignant tumor adjacent to sacroiliac joint, including 15 cases of osteosarcoma (51.7%) and 7 cases of Ewing sarcoma (43.8%). Chondrosarcoma was found in 4 cases (11.4%) and chordoma in 1 case (7.7%). There was no significant difference in the incidence of transarticular invasion between primary malignant bone tumors of ilium and sacrum (蠂 ~ 2 = 1.06 P 0.05). There was significant difference in the transarticular invasion between the higher malignant tumor group and the lower malignant tumor group (蠂 ~ 2 = 16.68 P 0.01). Twenty-seven tumors were connected through ligaments 25 times. 13 times of transarticular cartilage and 5 times of transarticular involvement across the sacroiliac joint, there were significant differences among the three kinds of invasion modes (P0.05). There was no significant difference in the probability of transarticular invasion between the higher malignant degree tumor group and the lower malignant degree tumor group (P0.05). Conclusion MRI is highly sensitive to the cross-articular invasion of bone tumors adjacent to sacroiliac joint. There was no significant difference in the incidence of transsacroiliac joint invasion between primary malignant tumors of ilium and sacrum adjacent to sacroiliac joint. The transsacroiliac invasion rates of common osteosarcoma and Ewing sarcoma were significantly higher than those of central chondrosarcoma and chordoma with lower malignant degree. Bone neoplasms are associated with transarticular invasion through ligaments, and their transarticular invasion is not related to the malignancy of the tumor.
【作者单位】：中山大学附属第一医院放射科;
【分类号】：R738;R445.2

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