大骨节病小梁骨坏死的组织学形态再观察

Reexamination on Histomorphology of Necrosis of Trabecula Bones in Kaschin-Beck Disease

有关大骨节病 (KBD)有无小梁骨坏死病变一直存有争议。为全面认识 KBD的病理变化 ,本文在光镜下复查了本所尸检档案 2批共 16例的骨切片。按本文拟出的诊断小梁骨坏死的 3个条件 ,在第 1批 10 / 12例、第 2批 4 / 4例的众多四肢骨和中轴骨内检出小梁骨坏死病变。其形态特点是 :小梁骨坏死呈灶状分布 ;新近坏死者位于并存的骨髓血细胞坏死灶内 ,坏死崩解的骨碎屑与坏死的血细胞镶嵌存在、接触紧密 ;时久 ,骨碎屑显示“死骨”的形态改变 ,最终骨碎屑被包裹 ,位于囊肿内 ;小梁骨坏死灶外的邻近区 ,其固有组织结构自然存在。 KBD病尸内 ,小梁骨坏死是确切存在的 ,是 KBD骨内病变的重要组分之一。小梁骨坏死及并存骨髓血细胞坏死的原因不排除本病急性病毒性骨髓炎时继发

A dispute whether there is trabecula bone necrosis or not in Kaschin Beck disease (KBD) is continuous as yet. To overall know the pathological changes of KBD,the bone sections of 16 cases (2 batches) of our own autopsy files were reexamined with light microscope. According to the 3 conditions, which are formulated by this paper, for diagnosis of trabecula bone necrosis, the trabecula bone necrosis was seen in many auxilliary and axis bones of 10/12 cases of the first batch and 4/4 cases of the second batch. The morphological characteristics are as follows: the distribution of trabecula bone necrosis was focal; recently developed necrotic bones were located within simultaneous necrotic foci of blood cells of bone marrows; necrotic and disintegrated bone debris were inlaid with necrotic blood cells and attached closely to each other; later, the bone debris showed morphologic changes of 'died bone', finally, bone debris were often encapsulated and located in cysts; about the necrotic foci of trabecula bones, the proper histologic constitutions were natural. It is true, that there is necrosis of trabecula bones in corpses with KBD, and it is one of important constituents of lesions in bones with KBD. The causes of necrosis of trabecula bones and of blood cells in bone marrows don't eliminate a possibility resulted from acute viral osteomyelitis and secondary type Ⅳ hypersensitivity.