【摘要】：目的觀察鄰近骶髂關(guān)節(jié)的骨原發(fā)惡性腫瘤跨關(guān)節(jié)侵犯的MRI表現(xiàn),比較不同部位、病理類型和分級的惡性骨腫瘤跨關(guān)節(jié)侵犯的發(fā)生率及侵犯方式之間是否存在差異性。方法分析2004年1月至2015年6月間經(jīng)手術(shù)病理證實(shí)的93例鄰近骶髂關(guān)節(jié)的髂骨(69例)和骶骨(24例)原發(fā)惡性骨腫瘤患者的臨床及MRI資料,男60例,女33例,年齡4~74歲,平均32歲,包括普通型骨肉瘤29例,尤文肉瘤16例,中央型軟骨肉瘤35例,脊索瘤13例。按病理惡性程度分為惡性程度較高腫瘤組和惡性程度較低腫瘤組�？琪诀年P(guān)節(jié)侵犯分為經(jīng)韌帶連結(jié)、經(jīng)關(guān)節(jié)軟骨和經(jīng)關(guān)節(jié)周圍三種方式,多種方式并存出現(xiàn)者按每種方式分別計(jì)數(shù)1次。數(shù)據(jù)處理采用SPSS 17.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果鄰近骶髂關(guān)節(jié)的骨原發(fā)惡性腫瘤跨骶髂關(guān)節(jié)侵犯27例,包括骨肉瘤15例(51.7%),尤文肉瘤7例(43.8%),軟骨肉瘤4例(11.4%)和脊索瘤1例(7.7%)。髂骨和骶骨原發(fā)惡性骨腫瘤跨關(guān)節(jié)侵犯發(fā)生率之間的差異無統(tǒng)計(jì)學(xué)意義(χ~2值=1.06,P0.05)。惡性程度較高腫瘤組和惡性程度較低腫瘤組間跨關(guān)節(jié)侵犯的差異具有統(tǒng)計(jì)學(xué)意義(χ~2值=16.68,P0.01)。27例腫瘤經(jīng)韌帶連結(jié)25次、經(jīng)關(guān)節(jié)軟骨13次和經(jīng)關(guān)節(jié)周圍5次方式跨骶髂關(guān)節(jié)侵犯,此三種侵犯方式的幾率之間差異均具有統(tǒng)計(jì)學(xué)意義(P0.05),惡性程度較高腫瘤組與惡性程度較低腫瘤組間的三種方式跨關(guān)節(jié)侵犯的幾率差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論 MRI對顯示鄰近骶髂關(guān)節(jié)的骨腫瘤跨關(guān)節(jié)侵犯具有非常高的敏感性。鄰近骶髂關(guān)節(jié)的髂骨和骶骨原發(fā)惡性骨腫瘤跨骶髂關(guān)節(jié)侵犯發(fā)生率無明顯差異,普通型骨肉瘤和尤文肉瘤跨骶髂關(guān)節(jié)侵犯率明顯高于惡性程度較低的中央型軟骨肉瘤和脊索瘤。骨腫瘤多經(jīng)韌帶連結(jié)跨關(guān)節(jié)侵犯,其跨關(guān)節(jié)侵犯方式與腫瘤惡性程度無關(guān)。
[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.
【作者單位】： 中山大學(xué)附屬第一醫(yī)院放射科;
【分類號】：R738;R445.2

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