放射性下颌骨骨髓炎26例临床报告

由于头颈部恶性肿瘤应用放射治疗日趋普及。由此而引起的放疗并发症-颌骨放射性骨坏死或称放射性骨髓炎的患者也随之增多,近年的文献报道下颌骨放射性骨髓炎的发生率约为5%～15%[1,2]。现就作者1980年至今所见26例放射性下颌骨骨髓炎报道如下,并就其产生的原因和防治措施进行讨论。一、临床资料1性别和年龄:本组26例患者,男性18例,女性8例,男女比例为21∶1,年龄最大65岁,最小28岁,平均年龄46岁,其中40～60岁为20例,占80%。2肿瘤类型与部位:26例患者中鳞状上皮癌19例,腺癌7例。其中鼻咽癌7例,舌癌6例,扁桃体癌5例,口底癌5例,下颌牙龈癌3例。3…     

6例放射性皮肤恶性肿瘤的临床特征及其治疗

６例放射性皮肤恶性肿瘤的临床特征及其治疗杨志祥，王方薪，杨文峰，胡莎莎，李杰有关射线诱发恶性肿瘤的报道不断增多，近１０年来，我院收治了６例放射性皮肤恶性肿瘤，现报告于下：１临床资料１．１本组男３例，女３例。年龄３６～６１岁，平均４８．６岁。１．２致伤...     

砷性颌骨骨髓炎12例分析

砷制剂（As2O3）作为牙髓失活剂已被广泛用于临床,疗效良好,但由于砷制剂的毒性作用,临床上时有砷性骨髓炎发生。2001年8月～2004年10月,我们收治砷性颌骨骨髓炎12例。现报告如下。     

颌骨放射性骨坏死病因病理学研究的近期概况

颌骨放射性骨坏死（ＯＲＮＪ）是颌面部恶性肿瘤放射治疗后经常发生的严重并发症。本文综述了近年来国内外对其病因病理问题研究的进展情况，并提出今后应进一步研究的方向。     

甘露醇合剂治疗放射性口腔黏膜炎的临床观察

急性放射性口腔黏膜炎为头颈部肿瘤放疗中最常见的急性并发症，多在放疗后2～3周出现。口腔黏膜炎给患者带来极大痛苦，是临床上较为棘手的问题。2005年1月-2006年6月，笔者采用自制含漱液治疗急性放射性121腔黏膜炎48例，效果较好，现报告如下。     

CT和MRI在颌骨骨髓炎中的应用价值

目的：探讨颌骨骨髓炎的CT和MRI征象特点和其在颌骨骨髓炎中的应用价值。方法：对21例颌骨骨髓炎CT和MRI征象与手术病理结果对照和由双盲法分析确认。结果：MRI对骨髓水肿和病变在周围软组织中扩散范围的显示具有优越性，CT和三维重建可以准确直观地显示颌骨骨髓炎骨质改变的情况。结论：CT和MRI对颌骨骨髓炎的显示各有优缺点，在颌骨骨髓炎的诊断和治疗中具有重要价值。     

下颌骨造釉细胞瘤伴慢性颌骨骨髓炎1例

我科收治1例下颌骨造釉细胞瘤伴慢性颌骨骨髓炎患者，现报告如下。 病例患者男性，31岁，因左侧下颌一后牙龋坏5年，并于牙周反复流脓1年余人院。查体：左下第6齿残根，松动Ⅱ度，对应舌颊侧牙槽骨可扪及不规则骨质感肿物，呈球状突起，边界模糊，质较硬，无活动度，触痛不明显，有乒乓球感，表面皮温及颜色正常，左下第5、7齿松动工度，挤压膨隆的下颌骨，有脓液从左下第6齿残根牙周流出；辅助检查：口腔曲面断层片：下颌骨单囊性肿物伴骨髓炎，由左下第5齿至第7齿，对应牙根尖未见明显吸收（见图1）。     

放射性膀胱疾病的临床观察

目的 探讨盆腔放疗时引起放射性膀胱疾病的临床特点、诊断、治疗措施并结合文献资料进行讨论，为规范放射性膀胱疾病的诊断提供依据。方法 采用临床病例分析方法。结果 宫颈癌放疗时放射性膀胱疾病发生率大约在0.8%-2.96%，平均2.14%。放射性膀胱疾病可分为急性放射性膀胱炎，慢性放射性膀胱炎和放射性膀胱瘘3型。临床上最多见的是慢性放射性膀胱炎，其临床主要表现为无痛性肉眼血尿，又分为轻、重两度。诊断时应有明确的射线接触史，并超过剂量阈值，出现典型的临床特征。结论 笔者全面分析了放射性膀胱疾病的临床特点、分型、诊断依据等可提供作为拟订诊断标准的参考。     

慢性骨髓炎的介入治疗

慢性化脓性骨髓炎是临床常见的难治病,全身抗感染治疗效果差,复发率高;手术治疗创伤大,手术复杂,术后复发也不少见。根据导管药物灌注可提高局部药物浓度的原理,我们自1999年9月至2003年5月共收治22例慢性骨髓炎病例,用局部灌注药物治疗,获得良好的疗效,部分患者灌注后为手术治疗创造了条件,现报道如下。     

Dislocation of jaws

Pluri-directional tomographic and arthrotomographic findings are described in six patients with dislocation of the jaw severe enough to require medical assistance. A grooved defect along the posterior aspect of the condylar head was noted in two of the six patients. The arthrotomographic findings that were obtained in one patient that was dislocated at the time of the arthrogram did not suggest a meniscocondyle incoordination as a mechanism. However, arthrotomographic findings in the six reported cases suggest that significant intra-articular soft tissue damage may result.     

Fibrosarcoma of the jaws

The records of 14 patients with fibrosarcoma of the jaws — 10 in the mandible and four in the maxilla — from the files of the Netherlands Committee on Bone Tumours were studied. The mean age of the patients was 30 years; more men than women were involved; pain and especially swelling were the symptoms most frequently present. The radiographic appearance often indicated the malignant nature of the lesion. Histologically 42% of the tumours were low-grade malignant. The 5-year survival rate was 71%, which is more favourable than either fibrosarcoma located else-where in the skeleton or osteosarcoma of the jaws. Radical surgery is the therapy of choice. All cases with an unfavourable course acquired lung metastases.     

Multimodality imaging of osteomyelitis

Early diagnosis of osteomyelitis continues to be a clinical problem. Multiple imaging modalities are being used for the diagnosis of osteomyelitis, but none of them is ideal for all cases. The choice of modality depends on several factors based on an understanding of the pathophysiologic aspects of different forms of osteomyelitis. After a brief introduction outlining some basic principles regarding the diagnosis of osteomyelitis, pathophysiologic aspects are reviewed. Advantages and disadvantages of each imaging modality and their applications in different forms of osteomyelitis are discussed. The use of different imaging modalities in the diagnosis of special forms of osteomyelitis, including chronic, diabetic foot, and vertebral osteomyelitis, and osteomyelitis associated with orthopedic appliances and sickle cell disease is reviewed. Taking into account the site of suspected osteomyelitis and the presence or absence of underlying pathologic changes and their nature, an algorithm summarizing the use of various imaging modalities in the diagnosis of osteomyelitis is presented.     

Fibro-osseous lesions of the face and jaws

Maxillofacial fibro-osseous lesions (FOL) consists of lesions that differ, with the exception of fibrous dysplasia, to those found in the rest of the skeleton. FOLs of the face and jaws are cemento-ossifying dysplasia, fibrous dysplasia and cemento-ossifying fibroma. Radiology is central to their diagnosis because the pathology for all FOLs is similar, although they range widely in behaviour, from dysplasia, hamartoma to benign neoplasia with occasional recurrence. Furthermore, once diagnosed the management of each is different. For cemento-ossifying dysplasia, this may mean doing nothing, simply because no treatment is generally appropriate. Almost all cemento-ossifying fibromas should be treated surgically, whereas cases of fibrous dysplasia are treated according to their clinical presentation, ranging from review and follow-up to surgery necessary to save the patient's sight or reduce deformity. The most important and frequent features of the FOLs differential diagnosis is discussed with assistance of a flow-chart.     

Acute hematogenous osteomyelitis of the rib

Two cases of acute hematogenous osteomyelitis of the rib are presented. In one case the etiologic agent wasStaphylococcus aureus coagulasepositive and in the other it wasBacteroides corrodens. Although an uncommon disease, hematogenous osteomyelitis should be considered in the differential diagnosis of destructive lesions of the rib. Anaerobic and aerobic cultures should be obtained for bacteriologic analysis.     

抗生素骨水泥占位器在治疗慢性骨髓炎中的应用

目的探讨应用抗生素骨水泥占位器治疗慢性骨髓炎的临床疗效。方法回顾性分析2010年7月—2013年3月应用抗生素骨水泥占位器治疗慢性骨髓炎37例,男31例,女6例,年龄21~65(42.7±6.2)岁。清创前后均行细菌培养及药敏试验,根据结果指导全身应用敏感抗生素及相应类型抗生素骨水泥占位器。待感染控制后,取出抗生素骨水泥占位器,局部植骨治疗及更换内固定,直接缝合创口或行皮瓣移植。结果本组31例患者获得随访,6例患者失访,随访时间为9~24(17.2±2.3)个月。所有患者均应用2次抗生素骨水泥占位器,植骨愈合良好,其中27例重新植入内固定,29例行皮瓣移植覆盖创口,8例直接缝合创口。所有创口均愈合良好,局部无明显炎症复发迹象。结论应用抗生素骨水泥占位器治疗慢性骨髓炎是一种简单而有效的方法。     

全身MRI在慢性复发性多灶性骨髓炎中的诊断进展

慢性复发性多灶性骨髓炎(CRMO)是好发于儿童和青少年的自身炎症性骨病,临床表现及实验室检查缺乏特异性。CRMO早期X线表现可正常,中晚期呈进行性长骨干骺端骨质破坏、硬化或骨皮质增厚等骨髓炎改变。全身MRI检查发现多灶性、对称性骨病,或锁骨、下颌骨单发病变对该病的诊断具有重要提示作用。就CRMO的临床表现、发病机制、全身MRI表现、鉴别诊断及治疗进展进行综述。     

脂质体庆大霉素治疗慢性骨髓炎的实验研究

目的：探讨不同脂质体庆大霉素对兔胫骨慢性金黄色葡萄球菌骨髓炎的治疗作用。方法：制备阳离子、阴离子、中性脂质体，分别包裹庆大霉素制成不同的庆大霉素脂质体。常规构建兔胫骨骨髓炎模型，采用不同的庆大霉素脂质体或单独使用庆大霉素进行静脉注射治疗3w。治疗后行X线检查和细菌学检查，评价疗效。结果：阳离子庆大霉素脂质体的治疗效果显著优于阴离子、中性脂质体和单独使用庆大霉素，但仍不能达到100％治愈。单独使用庆大霉素出现了较严重的并发症。结论：阳离子脂质体改变了庆大霉素的药代动力学，可有效促进庆大霉素的骨髓内浓聚，是一种有效的非传统抗生素释药载体，对慢性骨髓炎的防治具有一定的应用前景，但在抗生素的选择和使用方法上仍有待进一步研究。     

Design and fabrication of a half-beam wedge for treatment of breast patients

Purpose: The Radiation Oncology Department of Kansas University Cancer Center on the average treats approximately 60 breast patients per year. Many of them require large field sizes with widths greater than 20 cm. Our purpose is to design a half-beam wedge that is lighter in weight than a standard wedge for larger field sizes. This could replace the compensator and reduce the number of monitor units. We have designed and fabricated half-beam wedges for a Varian linear accelerator, with the angles of 15, 30 and 45 degrees for a 6 MV photon beam. A set of dosimetry data for these wedges was entered into a treatment planning computer. The treatment plans generated using these newly designed wedges were compared with those using standard wedges. Methods and materials: From basic principles, the geometry for the design of the wedges was calculated for three angles, 15, 30 and 45. Using trays provided by Varian, three brass wedges were milled and attached to the trays. Measurements were taken in a water phantom with three wedge angles, 15, 30 and 45, for treatment planning purposes. Conclusion: The design and fabrication of a half-beam wedge for the use of treatment with large field sizes could reduce the need for fabrication of a compensator. This would also reduce the time required for treatment and give a better dose distribution.     

Acute osteomyelitis as a complication of varicella

Varicella is a common viral infection in childhood, and acute osteomyelitis is one of the rare but serious complications. We report two cases of osteomyelitis as a complication of varicella. The possibilities and limitations of the different imaging modalities are discussed, as well as imaging findings during the course of this condition.