创伤后骨质溶解症X线图像特征

Diagnostic X-ray of post-traumatic osteolysis of bone

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。

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 comminuted 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 oeteolytie area in 3 cases, no periosteal reaction and thickerning of bony cortex in osteolytic area in all 7 cases, 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, osteoneerosis, 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.