CAJ | 학술논문

目的探讨创伤后骨质溶解症的X线表现,提高对该病认识.方法回顾性分析经临床、病理证实的7例创伤后骨质溶解症X线表现.7例中女5例,男2例.年龄9～56岁,平均34岁.车祸3例,摔伤4例.受伤后距骨质溶解时间分别为18个月1例,10个月2例,6个月2例,3个月2例.结果受伤时X线示坐、耻骨骨折2例,胫腓骨下段骨折1例,股骨颈骨折1例,肱骨外科颈粉碎性骨折1例,肩锁关节Ⅰ度脱位1例,腕部软组织肿胀1例.X线表现为块状骨质溶解3例,斑片状骨质溶解3例,囊状骨质溶解1例;溶解边缘骨质均无硬化,其中溶解区界限清楚5例,界限不清楚2例;溶解区无残留骨组织4例,残留部分骨组织3例;溶解区附近骨质均未见骨膜增生和骨皮质增厚;骨质修复2例,溶解骨质无修复5例.病理检查显示病变区见大量毛细血管和纤维组织增生,滑膜充血肿胀、增生,肉芽组织增生,骨坏死,破骨细胞活跃,少量炎性细胞,无肿瘤细胞.结论创伤后骨质溶解症与外伤密切相关,X线表现为块状和斑片状骨质溶解或不规则骨质囊状破坏,早期诊断较难.
목적 탐토창상후골질용해증적X선표현,제고대해병인식.방법 회고성분석경림상、병리증실적7례창상후골질용해증X선표현.7례중녀5례,남2례.년령9～56세,평균34세.차화3례,솔상4례.수상후거골질용해시간분별위18개월1례,10개월2례,6개월2례,3개월2례.결과 수상시X선시좌、치골골절2례,경비골하단골절1례,고골경골절1례,굉골외과경분쇄성골절1례,견쇄관절Ⅰ도탈위1례,완부연조직종창1례.X선표현위괴상골질용해3례,반편상골질용해3례,낭상골질용해1례;용해변연골질균무경화,기중용해구계한청초5례,계한불청초2례;용해구무잔류골조직4례,잔류부분골조직3례;용해구부근골질균미견골막증생화골피질증후;골질수복2례,용해골질무수복5례.병리검사현시병변구견대량모세혈관화섬유조직증생,활막충혈종창、증생,육아조직증생,골배사,파골세포활약,소량염성세포,무종류세포.결론 창상후골질용해증여외상밀절상관,X선표현위괴상화반편상골질용해혹불규칙골질낭상파배,조기진단교난.
Objective To study the X-ray findings of post-traumatic osteolysis and to improve the knowledge of that disease.Methods X-ray features of 7 cases of post-traumatic osteolysis confirmed by clinical findings and pathology were reviewed retrospectively.There were 5 females and 2 males.from 9-56 years(mean 34 years)of age.Three patients had traffic accidents and 4 had trauma unrelated to traffic accidents.Osteolysis occurred from 3 to 18 months after trauma(1 case at 18 months,2 cases at 10 months,2 cases at 6 months and 2 cases at 3 months).Results There were 2 pubis fractures,1 distal tibiofibular shaft fracture,1 femoral neck fracture,1 humeral upper end commiuuted fracture,1 shoulder joint dislocation.and 1 soft tissue swelling around the wrist.The X-ray findings are:3 massive osteolysis,3 plaque flake osteolysis and 1 cystic osteolysis.There were no hardening of bony edge at the site of osteolysis in all 7 cases,clear margin in 5 cases and ill-defined margin in 2 cases,no residual bone in osteolytic area in 4 cases and residual bone in octeolytic area in 3 cases,no periosteal reaction and thickerning of bony cortex in osteolytic area in all 7 Cascs,bone repair in 2 cases and no bone repair in 5 cases.Histopathological findings showed:extensive capillary hyperplasia and fibrous tissue hyperplasia;hyperemia and swelling of synvium,proliferation of granulation tissue,osteonecrosis,increased osteoclast activity,some inflammatory cells,no evidence of neoplastic cells in the involved area.Conclusions Posttraumatic osteolysis is closely related to trauma.X-ray findings include massive osteolysis,plaque-like osteolysis,and irregular cystic changes.Early dignosis may be a challenging task.