上海LuOne凯德晶萃广场
LuOne凯德晶萃广场LuOne Mixed-Use Complex
上海 Shanghai已建成 Built2023综合体 Mixed-use
LuOne凯德晶萃广场位于上海市中心的老卢湾区，包含一个8层的商业广场和一座35层的办公楼，它将艺术、阳光和自然融入商业与办公的综合体验，创造出社区生活和特色商业的活力纽带。
LuOne凯德晶萃广场© Safdie Architects
LuOne凯德晶萃广场位于历史悠久、底蕴深厚的上海卢湾区，是一个集商业、办公、零售、娱乐于一体的综合中心。项目主要包含一座8层高的商业广场及一座35层高的办公楼，两者围绕中庭花园而建，为来此游玩和工作的人们提供市中心的宁静一隅。自2018年140,000平方米的商业广场开业至今，LuOne凯德晶萃广场已成为上海卢湾区的特色商业空间；如今，随着约45,000平方米的LuOne凯德晶萃广场办公楼（以下简称LuOne办公楼）正式启用，该项目终于完满实现了最初愿景，成为了一个充满活力、功能多元的“垂直城市绿洲”。
Safdie Architects announces the completion of LuOne Mixed-Use Complex, an integrated hub for dynamic businesses, retail, and entertainment in the historic Luwan district of Shanghai. Both the eight-level retail galleria and a 35-story office tower are organized around atrium gardens that provide visitors and workers with a serene destination in the heart of the city. The 140,000-square-meter (1.5M-square-foot) retail galleria has thrived since it opened in 2018. With the completion of the 45,000-square-meter (526,000-square-foot) office tower, the original vision is fully realized in this vibrant and programmatically diverse project.
Christopher Mulvey 萨夫迪建筑事务所高级合伙人
在卢湾区深厚的历史底蕴、稠密的城市环境和繁华的街道之中，LuOne商业广场的中庭和办公楼的转角花园，为建筑使用者在上海市中心营造了一处自然休憩之所。”"Amidst the density of the historic Luwan district and its busy boulevards, the galleria atrium and office corner gardens offer occupants a place for respite in the heart of Shanghai."
LuOne凯德晶萃广场© Safdie Architects
LuOne办公楼The Office Tower
位于场地东北角的LuOne办公楼，与商业广场的每一层空间及其屋顶的开放景观露台互相连通。办公楼的西南角特别设计为玻璃塔体，形成了160米高的“转角花园”（Corner Garden）。
Located on the northeast corner of the site, the office building integrates with the retail program at each level of the retail galleria including the publicly accessible landscaped roof terrace. Along the southwest edge of the office tower, a glass-enclosed “corner garden” ascends the 160-meter building.
LuOne办公楼 - 转角花园© Safdie Architects
设计以每4层为单位挑高，塑造了7个空中绿色空间，其间设有4米高的铁冬青树、多样的灌木，以及从空中花架倾泻而下的茂盛绿植——这些花园垂直堆叠，仿佛葱郁的植被攀上35层的高楼，将城市绿意自然地融入办公环境之中。
Seven gardens, each four stories in height and stacked vertically, incorporate specimen trees, mature shrubs, and vegetation cascading from ceiling-mounted planters, which create the appearance of greenery climbing the entirety of the 35-story tower.
Christopher Mulvey 萨夫迪建筑事务所高级合伙人
LuOne凯德晶萃广场回应了在上海核心城区与自然联系并营造社区的迫切需求。”"LuOne answers the pressing need for connection to nature and a place of community within Shanghai's urban core."
4层挑高的空中绿色空间© Safdie Architects
LuOne办公楼 - 大厅© Safdie Architects
LuOne商业广场Retail Galleria
八层高的商业广场是一个外向的空间，三条商业长廊将内部的商业空间与周围的街道连接起来，并在建筑中心形成了一个三角形的巨大中庭。参照大型温室花园的手法，设计以一根中心柱支撑起巨大的环形穹顶天窗，在商场三层打造出一处室内花园。天窗自穹顶向外辐射，延伸至三条商业长廊上方，使建筑从顶层至地下二层都能享受到充足的日光。
The eight-story retail podium is an extroverted space that organizes shops along three gallerias, which connect surrounding streets through the building and define a triangular atrium garden in the center. In the tradition of celebrated conservatory gardens, the atrium is enclosed by a grand toroidal dome skylight that springs from a central stem support on the third level. Linear skylights radiate out from the dome and bring daylight into the lowest levels of the gallerias, two stories below the street.
LuOne商业广场© Safdie Architects
环形穹顶天窗与商业廊道© Safdie Architects
三条商业长廊在建筑中交错汇聚© Safdie Architects
两层高的铜色立柱外衬于商业广场的沿街空间，并塑造了商场的入口。沿街商铺直接连通城市步道，不仅激活建筑边缘，也使建筑融入充满活力的公共领域。沿街外立面上方设置了美国艺术家内德·卡恩（Ned Kahn）的动态艺术装置——该作品由数十万块阳极氧化金属板组成，这些金属板悬挂在隐藏的横杆上，随风摆动、不断变化，以独特的视角呈现自然现象。
A two-story bronze colonnade lines the retail podium and frames each of the main galleria entrances. Shops at street-level also open onto the sidewalk, which activates the building edge and animates the public realm. The upper stories are adorned with a kinetic art installation by Ned Kahn, an American artist known for large-scale interventions that encourage observation of natural phenomena. The work consists of hundreds of thousands of anodized metal panels that swing on hidden horizontal rods in response to the breeze.
The complex is set back from the street edge, forming generously wide, landscaped promenades along Madang and Xujiahui Roads. A two-story bronze colonnade runs the length of each façade and frame the entrances to each of the gallerias. The four-stories above the colonnade are clad in a monumental kinetic art installation by the celebrated American artist Ned Kahn. Hundreds of thousands of anodized metal panels, hung on horizontal rods, sway in response to the wind, and create complex ever-changing patterns.
项目信息 / Credits
凯德晶萃广场 LuOne Mixed-Use Complex
项目业主：CapitaMalls Asia设计建筑师：萨夫迪建筑事务所负责合伙人：Moshe Safdie, Christopher Mulvey, Sean Scensor设计团队：Brian Black, Christopher Guignon, Howard Bloom, Hu Qi Wei, Jane Zimmerman, Michael McKee, Nan Xiang, Stephen O'Brien, Tunch Gungor, Ye Yang执行建筑师：上海建筑设计研究院有限公司工程总包：中国建筑一局(集团)有限公司结构工程：ArupMEP工程：Arup景观设计：Coen + Partners（USA）景观深化设计：意格国际（北京）室内设计：办公室内：上海结宇建筑设计有限公司商场室内：AGC Design Ltd.照明顾问：Brandston Partnership (BPI)其他专业顾问：幕墙工程: SchmidlinLEED 环境工程: ArupClient: CapitaMalls AsiaDesign Architect: Safdie ArchitectsPartners: Moshe Safdie, Christopher Mulvey, Sean ScensorDesign Team: Brian Black, Christopher Guignon, Howard Bloom, Hu Qi Wei, Jane Zimmerman, Michael McKee, Nan Xiang, Stephen O’Brien, Tunch Gungor, Ye YangExecutive Architect: SIADR (Shanghai Institute of Architectural Design & Research Co., LTD.)General Contractor: China Construction First Bureau Company LimitedStructural Engineer: ArupMEP Engineer: ArupLandscape Architect: Coen + Partners, USALandscape Design Institute: Ager Group, BeijingInterior Designer: Office Interiors: Shanghai Jieyu Architecture Design Co., Ltd.; Retail Galleria: AGC Design Ltd.Lighting Consultant: Brandston Partnership (BPI)Other Specialty Consultants: Façade Engineering: Schmidlin; LEED Environmental Engineer: Arup
资料来源、版权所有:萨夫迪建筑事务所
【教学病例】坏死概论骨缺血性坏死和骨梗死治疗前后典型影像表现
上一篇文章【中英文科普医学影像：fracture骨折概论、各种不同类型骨折、形成机制、治疗方法及并发症典型影像表现及随访教学病例解析】，主要简单讲解了骨折的基本知识和影像表现。
The Previous article described essential content and imaging appearance about fracture.
本文主要讲述骨缺血性病变（骨缺血性坏死和骨梗死），包括前言、坏死概论、骨缺血性病变诱因、骨缺血性坏死和骨梗死临床表现和典型影像表现、治疗及随访、小结六个部分组成。
The article is about ischemic bone diseases(e.g. avascular bone necrosis and bone infarct) and including six parts of preface,necrosis,cause,clinical history and image appearance,traatment， follow-up .
一、前言
骨缺血性病变，包括骨缺血性坏死和骨梗死；
Ischemic bone disease includes avascular bone necrosis and bone infarct.
骨缺血性坏死是骨组织（密质骨和松质骨）失去血供后骨组织细胞死亡；
Avascular bone necrosis occurs when cell died due to loss of blood flow to bone tissue(compact and spongy bone) by intrinsic or extrinsic factors.
骨梗死，是松质骨血供阻断后骨组织细胞死亡。
Bone infarct happens when something blocked flow of blood to spongy bone tissue .
影像检查首选DR，简单、方便、便宜；CT显示更多骨组织改变细节，尤其对于骨缺损、硬化、碎骨片显示更明显；MRI对于骨髓水肿和周围软组织显示更为优越。早期诊断MRI更敏感。
DR is first line modality because of cheap,convience,easy.CT is good at more details about bone deficit,scloerosis,fragments.MRI is sensitive to bone marrow edema and soft tissue at early stage.
治疗包括保守治疗和手术治疗。
Management is conservative treatment and surgery.
二、坏死概论
细胞死亡是细胞组织的功能丧失、结构溶解、消散，主要包括程序性死亡（自我吞噬、细胞凋亡）和非程序性死亡（坏死）。
Celluar death is dysfunction, self-destruction,vanishing of cell tissue.which includes programmed death(autophagy,apoptosis) and non-programmed death(necrosis).
自我吞噬是细胞面临生存压力时充分利用主动碎裂细胞的成分来高效运转、保持活力，这是一种程序化、可控的自然现象。
Autophagy is programmed and undercontrol natural phonemenon when cell broke down and utilized old cell framents to operate more efficiently for surviving.
细胞凋亡是多细胞的组织、器官按计划组织部分细胞破坏或死亡，时刻保持组织、器官的活力，避免过多细胞癌变可能。这是细胞正常、自然的生理性替换。
Apoptosis is a form of programmed death to keep alive when cell self-destruct and dies in void of cancer.It is normal and physiological replacement.
坏死是由于内部和外部的因素导致细胞不可控的突然死亡、溶解，是一种非正常、意外的细胞死亡，通常伴有其他破坏性的改变如炎症等。内外部因素包括疾病、感染、外伤、各种原因导致缺血等。
Necrosis is sudden and incidental celluar death or self-destruction with inflammation due to uncontrollable intrinsic and extrinsic factors(blockage of blood for disease,infection,trauma,etc.).
下图是细胞凋亡和细胞坏死的对比。
The following image shows comparison apoptosis to necrosis.
坏死形式主要包括凝固性坏死、液化坏死、干酪样坏死、脂肪坏死、纤维坏死、坏疽等。
The pattern of necrosis includes coagulative necrosis,liquefactive necrosis,fat necrosis,caseous necrosis,fibrinoid necrosis,gangrenous necrosis.
下图显示病理图片坏死细胞。
The following image shows celluar necrosis of pathological case.
下图显示不同形式坏死病理图片。
The following image shows different patterns of necrosis.
坏死的类型包括骨缺血性坏死、胰源性坏死、乳腺脂肪坏死、急性肾小管坏死、集合管坏死、放射性坏死、皮肤坏死等。
The types of necrosis includes avascular necrosis(osteonecrosis),pancreatic necrosis,fat necrosis of breast,acute tubular necrosis,renal papillary necrosis,radiation necrosis,skin necrosis,etc.
下图是皮肤坏死，注意坏损的皮肤呈完全黑色，周围皮肤肿胀呈炎性改变。
The following image shows skin necrosis,notice complete black skin necrosis with severe inflammatory swelling adjacent normal skin.
下图是上颌骨的缺血性坏死，注意骨质和周围皮肤组织都呈灰色和黑色改变。
The following image shows osteonecrosis of the jaw.notice bone and skin demonstrates gray and black.
下幅示意图显示肾小管的坏死。
The following image illustrate acute tubular necrosis.
下图是典型的坏疽，远端指骨/趾骨皮肤呈黑色，这是一种不可逆的改变。
The following image shows irreversible black skin of characteristic gangreneous necrosis in phalanges and phalanxes.
三、骨缺血性病变诱因和病理过程
骨缺血性病变，顾名思义，就是没有血流的供应或原来正常血供中断无法正常给予骨组织正常营养支持导致的坏死。
Avascular bone necrosis(AVN) is bone celluar death due to interruption or decrease of blood flow.
诱因主要包括血管内因素、血管因素、血管外因素、特发性因素。
Causes includes intravascular factors,vascular factors,perivascular factors,idiopathic factors.
1、血管内因素：镰状细胞贫血、脂肪栓塞、减压病引起的氮气栓塞、真性红细胞增多症。
2、血管因素：血管炎（狼疮、放射性诱导）。
3、血管外因素：外伤、骨折破坏血管。
4、特发性因素：外源性类固醇滥用、酒精依赖、库欣综合征、儿童股骨头骨骺缺血性坏死。
1.intravascular factors:
sickle cell anemia
fat embolism
nitrogen embolism by decompression disease
polycythemia vera
2.vascular factors:
vasculitis，
systemic lupus erythematosus,
radiation.
3.perivascular factors:blockage of blood flow by trauma,fratcture
4.idiopathic factors:
prolonged steroid use;
excessive use of alcohol
Cushing syndrome
legg calve perthes disease
病理过程：正常的骨组织细胞需要支持血管的营养支持、稳定骨内压、正常的成骨和破骨的代谢流程，任何一个环节出现问题都会导致缺血性坏死。
Pathological process:Normal bone cell depend on nutrition from blood supply,stable intraosseous pressure,osteoclast and osteoblast metabolism.Problem in any part will cause avascular necrosis.
血管内外的因素导致血管狭窄、甚至闭塞，都会破坏支持血管的血供，导致血液减少。比如各种原因的血管炎引起的血管狭窄，各种血液疾病引起的脂肪沉积栓塞，减压病引起的氮气栓塞，外伤和骨折、关节脱位直接破坏支持血管。类固醇等激素的过度使用，导致血管脂肪沉积、血供减少、骨内压减低、破坏或减缓成骨代谢的过程，直接导致骨缺血性坏死。酒精依赖中大量酒精导致人体血脂代谢紊乱，产生大量脂肪，沉积在血管，血管纤维变性和粥样硬化，管腔狭窄，血液减少，导致骨缺血性坏死。
Intra- or peri-vascular factors may lead to decrease or disruption of blood flow for narrowed or occult vessel.
Vasculitis from various factors cause worsening narrowed vessels.
Fat and nitrogen deposit to block the blood flow.
Trauma,fracture and dislocation break down and interrupt supply vessels.
Prolonged use of steroid may cause avascular necrosis due to fat deposition,decrease of blood flow and intreosseous pressure,impairing process of bone metabolism.
Disorders of lipid metabolism due to alcohol abuse lead to more lipid deposit in the vessels and narrow the lumen with firous degeneration and atherosclerosis. It reduce blood flow and cause avascular necrosis.
骨缺血性坏死早期由于缺少支持血管的营养支持，部分正常骨细胞营养缺乏、被动死亡，骨小梁纤细或中断，中期产生的死骨细胞开始吸收，发生囊变、硬化，骨小梁结构破坏、碎裂，骨组织变扁、塌陷，晚期影响到邻近关节软骨，引起关节的骨质破坏。
At early stage of AVN,bone cell passively died due to loss of blood flow,trabecular become thinner or interrupted;
At middle stage,bone cell aborbed sequestrum(dead bone)and osteocyst,osteogenesis,structure of trabecular is impaired and broken,formation flatten and collapse.
At late stage,bone cell directly injury adjacent joint cartilage.
下图是股骨头血供的示意图，注意营养血管主要集中在股骨头陷凹及颈部。当血供受各种因素影响减少（比如股骨颈骨折），中心骨组织坏死，无法承重，股骨头变扁、甚至塌陷。
The following image shows blood supply of femoral head,notice vessels surround femoral neck and fovea for ligment.Bone cell died and wear out ,femoral head flatten and collapse when blood flow reduce for fracture of femoral neck.
下图是腕关节的血供示意图，桡动脉分出掌侧和腕侧分支血管，腕侧血管分支营养支持手舟骨和月骨等腕骨，注意是从远端经腰部到近端。所以手舟骨缺血性坏死近端多见。
The following image shows blood supply of wrist.Radial artery has carpal branch and palmar branch.The carpal branch supply the blood of the scaphoid and lunate from distal to proximal by waist.This is why necrosis of proximal pole is more often.
四、骨缺血性坏死
骨缺血性坏死是因血液缺乏或减少引起的一系列骨组织坏死病变，其中股骨头缺血性坏死是最典型的代表，其他部位包括肱骨头、腕骨（手舟骨、月骨）、距骨、跟骨等。比较特殊的是股骨头骨骺缺血性坏死，这个后面单独讲。
Avascular bone necrosis occur when bone tissue died due to lack or loss of blood supply,AVN in femore head is characteristic,other includes humeral head,wrist(scaphoid,lunate),talus,calcaneus,etc.AVN in epiphysis of femoral head is special.
（一）股骨头缺血性坏死
Avascular necrosis in femoral head
临床表现：患肢运动疼痛、压痛、活动受限、跛行或“4“”字试验阳性；早期患骨负重或运动疼痛、受限，休息时无症状；中晚期无论休息与否持续疼痛，患肢挛缩、肌肉萎缩、屈曲、内收畸形改变。
Clinical manifestation:patient present with pain,limitaion of motion,limp，positive for figure 4 sign.At early stage,feel pain or limitation due to weight-bearing or motion.At late stage,affected limb demonstrates shortening,atrophy,deformation for flextion or abdcution.
如下图4字征试验(盘腿实验，髋外展外旋试验)。
figure 4 sign(also called Faber test,patrick test).
病理：外伤后、过量饮酒、激素滥用。
Pathology:trauma,alcohol abuse,excessive use of steroid.
外伤后股骨头缺血性坏死主要由于骨折或脱位破坏供血动脉或滑膜囊损伤，血供减少所致。
Traumatic avascular necrosis of femoral head occur due to loss of blood flow when fracture or dislocation broke blood supply or injuried synovial capsule.
过量饮酒和激素滥用会产生血管炎性改变、动脉粥样硬化、管壁纤维及玻璃样变性、脂肪沉积、骨内压改变、骨正常代谢抑制多种原因导致缺血。
Alcohol abuse and excessive use of steroid may lead to inflmmation,atherosclerosis,fibroids and hyaline degeneration,lipid deposition,intraosseous pressure change,inhibiting bone normal metabolism and cause loss of blood supply.
早期（坏死期）骨细胞坏死，骨小梁纤细或中断；中期（修复期）吸收死骨，骨质出现囊变、硬化、扁平；晚期（股骨头塌陷期）骨质完全破坏，关节间隙狭窄，对应关节面软骨破坏。
At early stage(necrosis),bone cell died and trabecular become thinner and interrupted;at middle stage(remodelling),sequestrum is absorbed and bone demonstrages cyst,sclercosis,flat ;at late stage(collapse),femoral head collapsed and injuried joint cartilage,space is narrowed.
影像特征和表现：
Imaging feature and appearance:
股骨头缺血性坏死最常见的分期包括Ficat 分期和ARCO分期。Ficat分为6期而ARCO分为4期。我们以ARCO分期为例：
Classification for AVN of femoral head includes Ficat(stage 6) and ARCO(stage 4).The following is ARCO classification.
ARCO I期：DR无异常。CT可见股骨头形态良好，股骨头承重区条形低密度影；MRI可见股骨头软骨下T2WI-FS小条形高信号。
Stage I:DR is normal.CT demonstates good silhouette and stripe low density under weight-bearing area.Subchondral demonstrates stripe high signal intensity on T2WI.
ARCO II期：股骨头无塌陷，髋臼无受累。DR可见股骨头骨质密度减低，新月征，边缘可有骨质硬化；CT可见股骨头形态尚可，股骨头承重区密度明显囊变和硬化交替；MRI可见股骨头软骨下T2WI-FS小条形高信号及低信号硬化缘。
Stage II:No collapse in femoral head and no injury to acetabulum is revealed.DR demonstrates low density and crescent sign with sclerotic margin;CT demonstrates both cyst and sclerosis density in femoral head within normal contour;T2WI demonstrates stripe high signal intensity with low signal intensity sclerotic margin.
下图可见新月征，软骨下见细条形低密度影，股骨头形态良好。
The following image demonstrates thin stripe low density(also called cresent sign) in femoral head with good contour.
T1WI可见左侧股骨头软骨下线性低信号(ARCO I期)；右侧斑片状低信号（ARCO II期）。双侧股骨头形态尚可。
The following T1WI shows linear low signal intensity in subchondral of left femoral head（stage I）;patchy low signal intensity(stage II)。The silhouette of bilateral femoral head is within the limitation.
同一患者T2WI-FS可见左侧线性高信号；右侧斑片状高信号，股骨头承重区明显低信号，符合死骨形成。
T2WI-FS of same patient shows linear high signal intensity in left femoral head;patchy high signal intensity in right femoral head. extreme low signal intensity in weight-bearing area tips sequestrum(dead bone).
ARCO III期：股骨头轻度塌陷，髋臼无受累。DR可见股骨头变扁或轻度塌陷，骨质密度明显不均，高低混杂，可见囊变、多发骨质硬化，新月征；CT可见股骨头变扁或轻度塌陷，股骨头承重区密度明显囊变和硬化；MRI可见股骨头软骨下T2WI-FS多发条形高信号、囊变影及低信号硬化缘，可见双线征。
Stage III:The femoral head slightly collapsed without injury to acetabulum.DR demonstrates flat hetergenous density femoral head with cyst and sclerosis,crescent sign is revealed.CT demonstrates flat femoral head with more indistinct osteolysis and osteosclerosis.T2WI demonstrates multiple stripe and cyst high signal intensity with low signal intensity margin,double line sign is revealed.
下图左侧为正常股骨头，右侧为股骨头缺血性坏死。股骨头扁平，骨质密度不均，可见多发条形、小囊性低密度影、斑片状、高密度影，股骨头轻度外上移位，Shenton和calve线不连续，提示半脱位。
The following left image shows normal femoral head.Right image shows AVN of femoral head is stipe and pathcy mixed density.The flat femoral head displaced superolaterally, uncontinuous Shenton and calve line tips subluxation of hip joint。
下图左侧为正常股骨头。右侧股骨头碎裂、塌陷，骨质密度不均，髋臼未受累。
The following image shows left normal femoral head, fragmented right femoral head collapsed without injury to acetabulum.
ARCO IV期：股骨头完全塌陷，髋臼受累。DR可见股骨头完全塌陷，骨质密度明显不均，骨质囊变和硬化广泛，关节间隙明显狭窄，髋臼边缘骨质硬化；CT可见股骨头完全塌陷，股骨头承重区密度明显骨质囊变和硬化，间隙消失，髋臼边缘毛糙、硬化，关节囊见较多液体密度影；MRI可见股骨头软骨下T2WI-FS多发条形高信号、囊性高信号及低信号硬化缘，信号驳杂，对应关节面软骨完全碎裂，破坏，关节腔见大量液体密度影。同侧软组织萎缩。
Stage IV:The femoral head completely collapse and injury to adjacent acetabulum.DR and CT demonstrates density of complete collapsed femoral head is heterogeneous with osteolysis and ostelsclerosis.The joint narrowed with sclerotic acetabular margin.CT demonstrates more detail about silhouette and density of femoral head. MRI demonstrates subchondral multiple stripe and cyst high signal intensity with low signal intensity margin.The cartilage of hip joint is broken and fragmented and effusion in joint cavity and synovial capsule is revealed.Ipsilateral muscle and soft tissue atrophy moderate or severe.
下图DR可见双侧股骨头完全塌陷，承重区骨质碎裂，可见多发囊性破坏和斑片状硬化灶。关节间隙完全消失，对应髋臼受累、硬化。
The following DR shows bilateral femoral head completely collapsed with fragments,osteolysis,osteosclerosis.The joint space totally disappeared with sclerotic acetabulum.
下图T1WI可见股骨头缺血性坏死，左侧为ARCO IV期，骨质碎裂，髋臼受累；右侧为ARCO III期，可见骨质环形低信号，中心见死骨。
The following T1WI shows AVN of bilateral femoral head.The classification of left femoral head is stage IV with fragments and injury to acetabulum;right is stage III with sequestrum surrounded by low signal intensity.
同一患者T2WI-FS可见左侧髋关节间隙明显变窄，对应关节面呈不均高信号；右侧呈环形高信号并中心死骨，呈双线征。
T2WI of same patient shows the left joint sapce is narrowed and intensity of joint face is uniformly increased. The right femoral head indicates sequestrum with rim high signal intensity(also called double line sign).
（二）股骨头骨骺缺血性坏死
股骨头骨骺缺血性坏死是在青少年时期影响髋关节非常少见的一种疾病。因各种原因骨骺缺少血液营养出现坏死。
主要症状：活动时髋关节疼痛，休息时缓解。活动受限或身体僵硬。
Avascular necrosis of femoral head epiphysis is a rare childhood condition affecting the hip joint.Necrosis of epiphysis is revealed due to lack of blood flow for various factors.
symptoms:Pain with activity in the hip joint and releaf when rest.
stiffness or decrease of the motion.
下图可见右侧股骨近端骨折并内固定术后改变，断端骨痂形成，骨骺变扁、塌陷、碎裂、硬化，髋关节半脱位表现。
The following image shows fracture of upper shaft of femur with internal fixation and callus formation.Epiphysis is flattened,collpased,broken,sclerosis.The right hip joint is subluxation.
下图为蛙式位，可见左侧股骨头骨骺变扁，密度增高，轻度硬化。
The following frog-leg projection image show flattened and collapsed epiphysis of left femoral head with increase of density.
下图CT冠状位骨窗提示左侧股骨头骨骺完全碎裂，硬化。
The following coronal CT shows broken and sclerotic epiphysis of left femoral head.notice bone window.
T1WI显示左侧股骨头骨骺变扁、塌陷，头颈区信号弥漫性减低。
The following T1WI shows flattened and collapsed epiphysis and diffuse decrease of intensity in left femoral head and neck.
下图T2WI-FS可见头颈区弥漫性高信号，提示骨髓水肿；关节腔及滑膜囊内见液体高信号。
The following T2WI-FS shows diffuse high signal intensity in femoral head and neck tips bone marrow edema.The fluid of high signal intensity is revealed in joint cavity and synovial capsule.
下图是红色线为克雷线，左侧正常沿着股骨颈上缘的直线通过骨骺，右侧骨骺位于线下缘，提示股骨头骨骺滑脱，注意骨质碎裂（黄色箭头）。最重并发症就是股骨头缺血性坏死。
The following image shows line of Klein(red arrow) drawn along superior edge of left femoral neck which normally intersect epiphysis.The broken epiphysis of right femoral head localized inferior of the line tips slipped capital femoral epiphysis.The severe complication is avascular necrosis.
（三）腕骨缺血性坏死
腕骨缺血性坏死主要发生于骨折后桡动脉腕部分支破坏所致。腕骨骨折最常见手舟骨、月骨。手舟骨骨折主要分为远端（1）、腰部（2）、近端骨折（3），其中腰部骨折多导致近端骨质缺血性坏死。
Avascular necrosis of the wrist occur when interruption in carpal branch of radial artery after fracture.scaphoid and lunate is more often.The fracture of scaphiod includes distal,waist,proximal fracture.The fracture of waist lead to avascular necrosis in proximal pole.
下图为手舟骨腰部骨折，断端分离、硬化，提示缺血性坏死。
The following image shows distracted and sclerotic fragments of waist in scaphoid tips avascular necrosis.
下图依次是T1WI、T2WI、T2WI-FS，T1WI手舟骨腰部骨折信号不连续，T2WI可见远端信号尚可，近端骨质信号减低并见斑片状稍高信号，T2WI-FS可见手舟骨骨髓水肿，近端骨质明显。手舟骨远端和桡骨茎突骨质可见撕脱性骨折。
The following image shows T1WI,T2WI,T2WI-FS of MRI.T1WI shows uncontinuous low signal intensity in waist of scaphoid.T2WI shows ununiform intensity in distal pole and patchy slightly high signal intensity surrounded by low signal intensity in proximal pole.T2WI-fs shows bone marrow edema in proximal pole.Avulsion fracture is found in distal scaphoid and radial process.
DR可见月骨密度不均，多发骨质硬化，提示缺血性坏死。
DR shows ununiform density in lunate with osteosclerosis tips avascular necrosis.
（四）距骨缺血性坏死
距骨由于外伤等原因破坏血供血管导致缺血性坏死。
Avascular necrosis of talus occur when blood supply is destructed for trauma .
下图可见距骨变扁，骨质密度不均并多发硬化，关节间隙变窄。骨质密度均匀减低，骨小梁稀疏。提示骨质疏松。
The following image shows flattened talus in ununiform density with osteosclerosis. The space of ankle joint is narrowed and density is low.The less trabecular tips osteoporosis.
下图为距骨骨折治疗后复查，可见金属内固定物高密度影，距骨明显塌陷、骨质密度不均减低并多发硬化，骨质边缘毛糙。注意扁平足。
The following image shows post-surgery of talus fracture with internal fixation.The indistinct talus flattened with osteolysis and osteosclerosis.notice flat foot.
（五）跟骨缺血性坏死
跟骨缺血性坏死由于外伤等破坏血管导致。
下图踝关节间隙消失，骨质完全融合。跟骨和距骨变形，骨质密度不均，可见多发骨质硬化。腓骨下段骨质部分缺如。这是外伤后手术切除的。
Avascular necrosis of calcaneous happens due to loss of blood flow for trauma.
The following image shows disappeared space of joint and bony fusion.The deformation of talus and calcaneous is revealed with heterogenous with osteosclerosis.Lack of lower part of fibula shaft is due to surgery for trauma.
（六）放射性缺血性坏死
放射性缺血性坏死：多为肿瘤治疗后形成的。
Radiation necrosis occur when therapy tumor by x-knife.
下图为肺癌脑转移后放射性治疗后大片状坏死，ABC可见转移瘤异常信号，D为治疗后大片状不均强化。
The following image shows large area of necrosis of brain metastasis after lung adenocarcinoma by radiation therapy.Image ABC shows rim abnormal intensity and D shows large area of enhanced intensity after treatment of radiation.
五、骨梗死
骨梗死是由于松质骨营养血管减少或缺失导致骨组织坏死。
Bone infarct is bone tissue necrosis occur when factors cuts off blood supply to spongy bone.
临床表现和病史：多无临床表现，因其他原因就诊无意发现。少数因轻度不适检查发现。
Clinical manifestation and pathology:No symptoms and present for other cause.less is uncomfotable.
影像特征和表现：最常发生于长骨干骺端和骨干。最重要特征是中心骨髓基本无改变，可见连续清晰线性边缘异常改变，形如“地图状“或“烟囱内的烟雾状”改变。
Imaging feature and appearance:bone infarct localizes in metaphysis and shaft more common.The characteristic feature is sheet-like or smoke up in the chimney which center is normal bone marrow surrounded by continuous linear margin with abnormal density or intensity.
DR可见髓腔内见散在片状、地图状混杂密度影，形如地图状，中心呈低密度影，边缘连续的环形线性高密度影；骨皮质未见受累。CT显示中心均匀低密度影，边缘迂曲、环形高密度影；骨皮质未见受累。
DR shows patchy and sheet-like mixed density in medullary cavity with center normal bone marrow surrounded by circular high density.The cortex is not injuried.CT shows unifom low density with rim high density.
MR可见T1WI中心呈均匀脂肪高信号，边缘可见环形低信号；T2WI压脂像可见中心均匀低信号，边缘环形高信号。
T1WI shows center with uniform fat high signal intensity surrouded by low signal intensity;T2WI-fs shows center with uniform low signal intensity surrounded by low signal intensity.
鉴别诊断：内生软骨瘤，良性肿瘤性病变，一般无临床症状，多无意中发现或病理性骨折后发现。多位于短骨，长骨偶尔发现。DR骨质呈膨胀性骨质改变，骨皮质受压弧形外突，骨质密度可均匀减低或合并砂砾状、点状、结节状钙化，无清晰硬化缘。CT显示散在钙化更为清晰，无环形硬化缘。MRT1WI呈不均低信号，T2WI呈不均高信号，中心钙化灶呈低信号。
Differential diagnosis:Enchondroma is benign tumor with no symptoms.It is revealed for unrelated check or with pathological fracture.
DR shows expansile lesion with concaving intact cortex and density is uniform decreased or with dot-like,nodular calcification.
CT shows more detail about calcification with no sclerotic edge.
T1WI shows ununiform low signal intensity and T2WI shows ununiform high signal intensity with low signal intensity in calcification.
下图为骨梗死DR典型表现，股骨及胫骨见大片状混杂密度影，中心低密度并环形硬化缘高密度影，形如地图状或烟囱中的烟雾状改变。
The following image shows characteristic feature sheet-like or smoke up in the chimney which indictes low density surrouded by high density.
下图CT显示细节更为清晰，中心低密度，边缘连续环形硬化缘。
CT shows more details about high density edge of lesion.
下图膝关节MRI，可见股骨及胫骨大片状异常信号，T1WI呈中心高信号，边缘环形低信号，T2WI-FS可见中心均匀低信号并边缘环形高信号，边缘毛糙。注意股骨关节面受累。
MRI of knee joint shows large area lesion in femur and tibia which indicates center high intensity with low intensity edge.T2WI-fs shows center low intensity with indistinct high intensity edge.notice injury to face of joint.
下图同一患者踝关节MR可见多发病灶。
The ankle MRI of same patient shows multiple lesions.
下图同一患者腰椎MR没有显示病灶，绿色箭头所示为脂肪变性。
The lumbar MRI shows no lesion but fat degeneration.
下图DR为内生软骨瘤，骨质膨胀性生长，骨皮质弧形受压、完整，密度不均中心见多发点状、砂砾状钙化灶，没有硬化缘。
The following DR shows enchondroma with expansile lesion and concaving intact cortex,density is heterogenous with dot,sand like calcification.no sclerotic edge is found.
另一位患者内生软骨瘤CT显示散在爆米花样钙化灶，无硬化缘。
The following image of another patient shows popcorn like calcification with no sclerotic edge.
六、骨缺血性病变治疗及随访
主要包括保守治疗和手术治疗。
Management includes conservative treatment and surgery.
（一）保守治疗Conservative treatment
1、保护性负重。weight-bearing with protection.walking aids such as canes and crutches.
2、西药治疗：磷酸盐类及抗凝、降脂类药物。
western medicine:Drugs for inhibiting osteoclasts and increasing osteogenesis(e.g. phosphate),may be indicated.other drugs(e.g. fibrinolysis promoters and vasodilators) is suitable in patients.
3、中医药治疗。traditional Chinese medicine emphasizes activating blood and reducing pain.
4、体外震波治疗。extracorporeal shock wave therapy.
5、电磁场治疗。high-frequency magnetic field therapy.
6、高压氧治疗。hyperbaric oxygen chamber therapy.
（二）手术治疗surgery
1、髓芯减压术core decompression surgery.
2、骨移植术,植入同种异体骨、自体骨、骨替代材料等。materials for bone graft includes allograft,autograft,synthetic bone fraft.
3、人工关节置换术arthroplasty（ artificial hip joint replacement）。
七、小结
本文主要讲解骨缺血性病变，重点讲述了骨缺血性坏死和骨梗死的影像特征和表现、治疗。
In summary,the article described imaging feature,appearance and treatment about ischemic bone diseases(avascular necrosis and bone infarct).
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