创伤后骨溶解症

Post-traumatic osteolysis of bone

目的探讨创伤后骨溶解症的临床表现、诊断及治疗方法。方法自1986年6月～2001年6月,共收治创伤后骨溶解症患者6例,男4例,女2例;年龄16～57岁,平均28.8岁。受伤原因:摔伤3例,车祸伤2例,运动性损伤1例。受伤部位位于坐、耻骨3例,锁骨远端3例。X线片显示骨溶解距受伤的时间分别为1个月3例,1.5个月1例,3个月1例,1例运动性损伤者确切时间不详。受伤时X线检查发现坐、耻骨骨折2例,肩锁关节Ⅰ度脱位1例,其余3例未见明显的骨折、脱位。分别对6例患者的临床表现、影像学资料、病理学表现以及治疗结果进行总结分析。结果5例发生于急性创伤后,1例发生于运动性损伤后,症状均以局部疼痛为主,部位集中于坐、耻骨及锁骨远端,影像学表现为局部骨溶解,经保守治疗后症状均能缓解,原骨溶解处均出现不同程度的骨重建,但骨重建迟于临床症状的缓解。所有病例病理显示纤维软骨组织增生,滑膜充血、增生,骨坏死,软骨下骨微骨折,破骨细胞活跃,可见骨组织化生和部分纤维化。结论创伤后骨溶解症与特殊部位急性创伤或运动性损伤关系密切,影像学表现为不规则的骨髓腔内水肿、囊性破坏或大范围的骨溶解吸收。创伤性骨溶解症早期诊断困难,应注意与恶性骨肿瘤相鉴别,其保守治疗效果好,适当使用骨吸收抑制剂能改变病程。

Objective To explore the clinical manifestations, diagnosis and treatment of post-traumatic osteolysis. Methods From June 1986 to June 2001, 6 patients were admitted to our hospital, there were 4 males and 2 females aging from 16 to 57 years (mean, 28.8 years). The cause of injury was fall in 3, traffic accident in 2, and sport injury in 1. The interval between trauma and present osteolysis ranged from one month to three month. The radiographic examination suggested that 2 patients suffered from ischiac and pubic fractures, 1 patient Ⅰ grade dislocation of acromioclavicular joint, and the other 3 patients no signs of fracture or dislocation at the time of injury. 2 patients underwent open biopsy, and the other 4 patients were identified as post-traumatic osteolysis based on medical history and X-ray films. Clinical manifestations, radiographic features and pathological manifestations of 6 cases with post-traumatic osteolysis were analyzed respectively. Results The patients were relived after conservative care of immobilization and medications. In clinical features, 5 patients resulted from acute trauma, and 1 case was caused by sport-related repetitive micro-trauma. All of the patients sustained similar clinical presentations, which included local pain with decreased joint range of motion. The most commonly affected region was distal clavicle, pubis and ischium. Radiographic changes were osteolysis of traumatic region. Follow-up radiographic examination, which was taken every month, demonstrated reconstruction of various degrees at the former osteolysis, although reconstruction of bone was behind clinical evidence of improvement. Conclusion Post-traumatic osteolysis may result from acute trauma or cumulative micro-trauma. Radiographic changes are varied, including irregularity of bone marrow edema, cystic erosions, cortical thinning or irregularity, and osteolysis. It is difficult to make diagnosis early, and must be distinguished the different of post-traumatic osteolysis from malignant bone tumors. Favorable outcomes may be achieved with conservative care. It may change the osteolytic process by using the osteolysic inhibitor.