骨质软化症中骨折的影像学鉴别诊断

Imaging differential diagnosis of fractures in osteomalacia

目的探讨代谢性及内分泌性骨病所致骨质软化中假骨折、真骨折和衰竭骨折的成因、诊断和鉴别诊断的意义及其临床价值。方法收集X线平片上具有骨质软化表现的病人36例,进行骨结构及骨密度的影像学分析。对18例出现骨折的病人进行骨折分类。对6例平片发现有假骨折线的病人行局部薄层CT扫描。对1例双侧耻骨上、下支有假骨折线的病人进行了6年的随访观察。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。18例出现骨折线的病例中13例诊为假骨折,3例为真骨折,2例为衰竭骨折。6例有假骨折病人行局部薄层CT扫描并三维重建,显示假骨折线走行较平片更加清晰。一例双侧耻骨上、下支出现假骨折的病人经治疗6年后假骨折线消失。结论在代谢性及内分泌性骨质软化症中出现的骨折线可以是假骨折、真骨折和衰竭骨折,归纳并提出了这三种骨折的诊断标准,薄层CT扫描和三维重建技术可以更准确地显示假骨折线。假骨折线可以作为监测病情发展情况的指标之一。

Objective To discuss the mechanisms of pseudofracture,true fracture and insufficient fracture in metabolic and endocrine osteomalacia,to investigate the significance on diagnosis and differential diagnosis,and to evaluate the clinical value.Methods Thirty-six patients who had osteomalacic appearance in radiograms were enrolled in this study.All of them were performed radiologic analysis of bone structure and density.Eighteen patients with fractures were classified.Six patients with pseudofractures line were examined by thin slice CT scan.One patient with pseudofractures in bilateral pubic upper and lower limbs was taken follow-up for 6 years.Results All patients showed bending deformity and abnormal density of bone on different level.Abnormal density included decreased and increased density.Thirteen patients had pseudofractures,3 had true fractures,2 had insufficiency fractures.Six patients who had pseudofractures underwent thin slice CT scan,which displayed pseudofracture line more clearly than plain film.After proper therapy for six years,the pseudofractures in bilateral pubic upper and lower limbs disappeared.Conclusion The fracture line in metabolic and endocrine osteomalacia may be pseudofracture,true fracture or insufficiency fracture.The diagnostic criteria of these three kinds of fracture was introduced.Thin slice CT scan and three-dimensional reconstruction technique can exactly display the pseudofracture line.The pseudofracture can be used as an imaging index of condition evaluation.