影像学评估代谢性及内分泌性骨软化的作用和限度

The role and limitation of imaging investigation on metabolic and endocrine osteomalacia

目的:探讨代谢性及内分泌性骨病所致骨质软化的一些影像学表现的成因及其在诊断和鉴别诊断上的意义。方法:收集X线平片上具有骨质软化表现的病例36例,进行骨结构及骨密度的影像学分析。对3例夹心椎病人进行随访观察。1例病人行骨组织形态计量学检查。结果:所有病例均有不同程度的骨弯曲变形和骨密度异常。骨密度异常包括骨密度减低和骨密度增高。骨密度减低见于所有病例的不同部位,分全身性及部分性。骨密度增高以椎体表现明显,分弥漫性密度增高及夹心椎2种。4例病人平片示双手指骨营养孔增大。2例未经恰当治疗病人分别于7个月和6年后出现夹心椎,1例经治疗4年后夹心椎表现消失。1例病人骨组织形态计量学检查诊断为骨质软化。结论:对影像学评估类骨质的能力以及骨质软化与骨质疏松的骨小梁影像学表现不同的原因作了进一步解释;夹心椎是代谢性及内分泌性骨病较常见的影像学表现,虽无诊断特异性,但可以反映病情的发展情况,可作为临床随访观察病情疗效的指标之一;骨营养孔增大可能是骨质软化的一个重要提示征象。

Objective： To discuss the mechanisms of some osteomalacic imaging features in metabolic and endocrinic disorders, and evaluate their signification in diagnosis and differential diagnosis. Methods： Thirty-six patients who had osteomalacic appearance in radiograms were collected in this study. All of them were performed radiologic analysis of bone structure and density. Follow-up examinations were performed at 3 patients with rugger-jersey spine. One patient underwent histomorphometry. Results：All pa- tients showed different degree bending deformity and abnormal density of bone. Abnormal density included decreased and increased density. Decreased density was found in different portions of all patients, which divided into general and regional type. Increased density was obviously in vertebrae, including diffusely in- creased density and rugger-jersey spine. Four patients showed enlargement of phalangeal nutrient foramina in plain film. After seven months and six years, the rugger-jersey spine appeared in 2 patients who were taken no proper therapy. The rugger-jersey spine disappeared in one patient who had accepted right therapy. One patient who underwent histomorphometry was confirmed osteomalacia. Conclusion： The ability of evaluation in osteoid tissue by imaging method, as well as mechanism of bone trahecular radiologic appear- ance in osteomalacia and osteoporosis are further explained. The rugger-jersey spine as a radiographic feature is more frequently in metabolic and endocrine bone diseases. Although rugger-jersey spine is not a specific feature for diagnosis, it may reflect the progress of disease. So it can be used as an imaging index of condition evaluation. Enlarging nutrient foramen of bone may be an important clue feature to diagnose osteomalacia.