小儿股骨头骨软骨炎分型

目的:小儿股骨头骨软骨炎骨骺变化迅速平片表现多样,如何从判断预后进行新的分型。材料和方法:2~13岁小儿60例,平均年龄8.26岁。其中2~5岁幼儿11例,6~13岁少儿49例。方法:是从股骨头骨软骨炎累及的不同范围进行分型。以简单明确、便于实用、符合发展、显示预后进行分型。结果:I型(轻)单纯骨骺坏死,骨骺碎小裂隙扁平9例(15%)。II型(中)骨骺干骺坏死,骨骺骨化不均,干骺端囊变硬化,股骨颈粗端39例(65%)。III型(重)骨骺干骺坏死加股骨头外移12例(20%)。结论:I型预后较好,髋臼发育不良者预后较坏。     

周围骨发育障碍的X线征象分析

目的:探讨周围骨发育障碍的X线征象,提高对该病的认识和诊断。方法:对我们收集的14例周围骨发育障碍患者的X线影像进行回顾性分析,总结其X线征象。结果:14例患者均可见指、趾骨干骺端呈杯口状凹陷,骨骺呈锥形陷入干骺端,骨骺早闭,骨龄提前,11例掌、跖骨粗短,骨端膨大,3例掌骨长短不一,9例指骨长度比例失调、末节指和中节指变短。结论:掌跖骨粗短、锥形骨骺、骨骺早闭是周围骨发育障碍典型的X线征象,X线检查结合临床资料可对其作出诊断。     

常见骨软骨缺血性坏死的X线诊断

目的探讨X线检查在骨软骨缺血性坏死诊断中的价值。方法对40例骨软骨缺血性坏死患者的常规放射资料进行回顾性分析。结果X线诊断股骨头骨骺缺血性坏死5例;胫骨结节骨软骨炎12例;耻骨联合骨软骨炎7例;剥脱性骨软骨炎6例;跖骨头缺血坏死7例;骨梗死3例。所有患者均有典型的X线表现。结论常规X线对骨软骨缺血坏死中晚期诊断有重要价值。     

儿童右下肢骨内淋巴管瘤病1例

该文报道1例儿童右侧下肢骨内淋巴管瘤病, 患儿男, 10岁。CT表现为右股骨远端干骺端及骨骺、右胫骨近远端干骺端及骨骺、右腓骨远端骨骺及右侧跟骨、距骨、局部跗骨多发大小不等囊状、条片状低密度影。MRI表现为病变区骨质内多发大小不等、形态各异囊状异常信号, 局部呈小片状, T1WI呈低信号, 脂肪抑制T2WI呈高信号, 与液态水信号相似。     

肾性骨营养不良的手、腕骺板损伤

作者报道了2例发生在肾性骨营养不良时手和腕关节的非外伤性骺板损伤。非外伤性股骨头骺滑脱比较常见,而上肢对称性骨骺滑脱及骺板损伤则相当罕见。作者回顾了以往文献发现一些年轻运动员尤其是体操运动员由于长期反复的压力或创伤作用于腕关节屈曲位时,可造成类似的骨骺和干骺端变化。作者提醒医生们注意,假若病人无超常体育运动史而发生上肢对称性骨骺滑脱,则提示病人有代谢性骨病存在的可能。     

是剥脱性骨软骨炎(病)?还是干脆性或干燥性骨软骨炎(病)?

到前为止,中文书刊将剥脱性骨软骨炎(病)称为干脆性或干燥性骨软骨炎(病),或两命混合应用。此可能由于译名有误所致。剥脱性骨软骨炎     

产后耻骨联合骨软骨炎1例报告

产后耻骨联合骨软骨炎１例报告湖北荆门市建工医院朱协炎，霍建国耻骨联合骨软骨炎（又称耻骨联合无菌性坏死Ｐｉｖｓｏｎ氏病），是由于外伤或强力牵拉造成局部血供障碍所致的骨骺坏死。产后耻骨联合骨软骨炎较少见。我院偶遇ｌ例，现报告如下：女，２４岁，建筑钢筋工人...     

骺板病变

骺板即骨骺软骨板(Epiphyseal car-tilage plate),是骨骺化骨中心与干骺端之间的软骨;当骨骺化骨中心增大到与其干侧相等时则该软骨呈板状。管状骨长度的生长主要靠骺板的软骨细胞的增殖与分裂,任     

长骨干骨软骨瘤2例

<正>骨软骨瘤(osteochondroma)是最常见的良性骨肿瘤。按WHO统计,骨软骨瘤占原发性骨肿瘤的19.89%,占良性肿瘤的43.80%,好发于长骨干骺端,仅少数发生在骨骺。长骨干骨软骨瘤极少见,     

先天性梅毒的骨骼表现

作者报告302例(年龄0～4个月)先天性梅毒中197例有骨骼改变者。X线发现有骨干炎:106例骨膜反应,20例骨炎。多数(72例)骨膜反应为单层,重者为多层如斗蓬,“蹄样”。骨炎常见于骨干,呈弥漫性虫蚀样(15例),次为局部缺损(5例)。干骺炎:为增生或破坏,呈透明或致密带,有的交错呈“三明治”样,21例胫骨上端内侧对称性侵蚀(Wimberger′s征),6例骨干与骨后板间角处侵蚀,干骺端锯齿样(Wegner′s征)     

Deferoxamine-induced bone dysplasia in the distal femur and patella of pediatric patients and young adults: MR imaging appearance

OBJECTIVE: We investigated the MR imaging appearance of deferoxamine-induced bone dysplasia in the distal femur and patella in patients with thalassemia major. MATERIALS AND METHODS: Thirty-five patients with homozygous ss-thalassemia major who were undergoing regular transfusions and chelation therapy underwent coronal T1-weighted MR imaging of the femur, including the femoral head and the distal femoral epiphysis. Additional coronal fat-saturated dual-echo and sagittal T1-weighted images of the distal femur and patella were obtained in 11 patients who were suspected of having distal femoral lesions on the basis of the coronal T1-weighted images of the entire femur. RESULTS: No dysplastic change was detected in the proximal femur on coronal T1-weighted images. In 22 distal femurs of 11 patients, the following abnormalities were detected on MR imaging: blurred physeal-metaphyseal junction (n = 22), distal metaphyseal areas of hyperintensity (n = 21), physeal widening (n = 18), metadiaphyseal lesions (n = 11), epiphyseal lesions (n = 10), and patellar lesions (n = 2). Physeal widening and distal metaphyseal hyperintense areas were all more pronounced peripherally. Of the 21 distal metaphyseal hyperintensities, lateral abnormalities were larger than medial abnormalities in 16. Of the 18 distal femurs in which physeal widening was detected, the lateral widening was more marked than the medial widening in 12. Patients with MR imaging evidence of bone dysplasia have a significantly (p = 0.003) greater height reduction than patients without such evidence of bone dysplasia. CONCLUSION: Deferoxamine-induced bone dysplasia in the distal femur and patella is represented by a spectrum of morphologic changes in the epiphysis, physis, metaphysis, and metadiaphysis on MR imaging.     

Chronic stress injuries of the elbow in young gymnasts.

The radiological changes of chronic stress injuries of the elbow in 19 adolescent elite gymnasts are reported. The principal abnormalities were avascular necrosis of the capitellar epiphysis (Panner's disease) (one patient), post-traumatic subarticular necrosis (osteochondritis dissecans) of the capitellum (six patients) and the medial articular eminence of the distal humerus (one patient). Flattening and anterior depression of the radial head epiphysis with an underlying metaphyseal notch associated with an epiphyseal cleft (three patients), which, in one patient who continued training, developed into a chronic Salter Type IV stress fracture. A further patient, post-epiphyseal fusion, showed osteochondritis dissecans of the anterior aspect of the radial head. Seven patients exhibited a spectrum of olecranon changes from fragmentation of the epiphysis to chronic Salter Type I stress fractures of the growth plate. A follow-up survey found that, of those who responded to a questionnaire, nearly all the patients with articular surface damage failed to continue with competitive gymnastics whereas those with olecranon abnormalities were able to continue gymnastics at the same level. The mechanism of injury and the pathological changes are discussed.     

Distal femoral epiphysis: normal standards for thickness and application to bone dysplasias

Flattening of the epiphysis of the long bones is seen in several bone dysplasias. It is the hallmark of multiple epiphyseal dysplasia and is an important sign in the diagnosis of spondyloepiphyseal dysplasias, diastrophic dysplasia, and pseudoachondroplastic dysplasia. The goal of this study was to determine norms for the height of the distal femoral epiphysis and to apply these standards to patients with bone dysplasias. Ratios of the distal femoral epiphysis height to both the distal femoral metaphysis width and the distal femoral epiphysis width were obtained from 640 radiographs of healthy children of different ages. Application of these standards to 41 patients with the bone dysplasias mentioned above proved useful in ascertaining decreased height of the distal femoral epiphysis. These standards are of particular value in subtle or early cases in which the thinning of the epiphysis may not be apparent upon simple observation. Obtaining three simple measurements from the anteroposterior knee radiographs allows determination of the presence or absence of flattening of the epiphysis.     

Normal and ischemic epiphysis of the femur: diffusion MR imaging study in piglets

PURPOSE: To evaluate normal diffusion characteristics in the femur in piglets and changes in diffusion with increasing duration of femoral head ischemia. MATERIALS AND METHODS: Normal epiphyses, physes, and metaphyses of piglets were evaluated with line-scan diffusion imaging (n = 12) and diffusion-tensor imaging (n = 4). Apparent diffusion coefficient (ADC) differences between normal proximal and distal femoral structures, epiphyseal and physeal cartilage, and epiphyseal and metaphyseal marrow were compared (Mann-Whitney test). Short-term femoral ischemia was investigated after maximal abduction of the hips for 3 hours (n = 6); ADCs before and after abduction were compared (Wilcoxon signed rank test). Prolonged ischemia was investigated with placement of a ligature around the neck of a femur (n = 7); the ADC of the femur in this condition was compared (Wilcoxon signed rank test) with that of the normal contralateral femur. Changes in ADC ratios at three durations of ischemia (Kruskal-Wallis test) were compared. RESULTS: ADC was greater in epiphyseal cartilage (mean +/- 1 SD, 1.62 x 10(-3) mm2/sec +/- 0.38) than it was in physeal cartilage (1.28 x 10(-3) mm2/sec +/- 0.31) (P <.007) and greater in epiphyseal marrow (1.26 x 10(-3) mm2/sec +/- 0.38) than it was in metaphyseal marrow (0.91 x 10(-3) mm2/sec +/- 0.35) (P <.001). There was columnar arrangement of tensors in the physis. ADC decreased 26% after 3 hours of maximal abduction. After femoral neck ligature, ADC increased a mean of 27% after 6 hours and a mean of 75% after 96 hours. CONCLUSION: Normal line-scan diffusion imaging findings indicate relative restriction of diffusion in the metaphysis and parallel orientation of tensors in the physis. Diffusion is initially restricted with decreased blood flow but increases if ischemia lasts longer.     

正常乳猪骨骺及干骺端骨髓的增强MR成像研究

目的 :探讨正常乳猪骨骺及干骺端骨髓的增强MR表现特征及不同年龄阶段的骨髓转化特征。方法 :8头乳猪 ,分别在出生 2、4、6和 8周的时间对双侧股骨近段及远段进行增强前后T1WIMR扫描 ,分析不同时间骨骺二次骨化中心骨髓和干骺端骨髓增强MR表现特征及增强率的变化 ,并与相应组织学发现进行对照研究。结果 :干骺端骨髓和骨骺二次骨化中心周边骨髓为含有丰富血管的红骨髓 ,增强后呈显著强化 ,且干骺端增强率较骨骺骨髓更高 ,但随年龄增长 ,两者的增强率均逐渐减低。骨干中央和二次骨化中心中央为黄骨髓 ,强化不明显。结论 :Gd DTPA增强在干骺端红骨髓与二次骨化中心周边红骨髓比在骨骺二次骨化中心中央区域黄骨髓强化更明显 ,其强化程度随年龄的增长逐渐减弱。     

Epiphyseal and physeal injury: comparison of conventional radiography and magnetic resonance imaging

PurposeTo compare conventional radiography and magnetic resonance imaging (MRI) in the assessment of epiphyseal and physeal injury.Materials and methodsSeventeen cases with epiphyseal and physeal injury were examined with conventional radiography and MRI. Two blinded experienced radiologists separately evaluated the results retrospectively.ResultsTwo Salter–Harris II fractures showed displacement of epiphysis and metaphyseal fragment, as well as T1 hypointensity and T2 hyperintensity in the physis on MRI. Three Salter–Harris IV fractures showed a fracture line in the epiphysis and metaphysis on two modalities, as well as linear T2 hyperintensity in the physis. All five slipped epiphysis showed signal intensity abnormality in the physis on MRI aside from the physeal widening and epiphyseal displacement seen on radiographs. Seven patients with bony bridge formation showed premature closure of the physis, shortening, and remodeling of the end of bones involved.ConclusionsConventional radiography and MRI are both useful in the diagnosis of epiphyseal and physeal injury. MRI can provide more detailed information, which could direct treatment planning and prognosis predicting.     

婴儿长骨急性血源性骨髓炎的MRI表现及其诊断价值

目的探讨婴儿长骨急性血源性骨髓炎的MRI表现及其诊断价值。资料与方法 21例长骨急性血源性骨髓炎病例均经临床及病理证实,9例采用Siemens Novus 0.35 T MR机,12例采用Siemens Avanto 1.5 T超导型MR机对病灶及邻近关节行轴位、矢状位及冠状位扫描。结果将婴儿长骨急性血源性骨髓炎分为三种类型:(1)骨骺干骺型(16例):病变位于股骨干骺端6例、胫骨干骺端5例、肱骨干骺端5例。16例长骨干骺端病灶合并骨骺及骺板受累、化脓性关节炎,其中2例合并骨膜下脓肿,1例合并骨骺分离,1例合并关节脱位,病灶在T1WI呈低或稍低信号,T2WI、PD-STIR及梯度回波序列呈高信号,以PD-STIR显示更明显;(2)干骺型(3例):病变位于股骨干骺端2例,胫骨干骺端1例,无骺板及骨骺受累,病灶呈片状稍长T1、长T2信号;(3)骨干型(2例):病变位于胫骨及尺桡骨骨干各1例,MRI表现为骨干广泛骨质破坏及骨膜反应。2例增强扫描髓腔内病灶及周围软组织见不均匀斑片状强化。结论婴儿长骨急性血源性骨髓炎有其自身发病特点,认识其病理解剖学基础及MRI表现,对评价骨髓炎的严重程度及预后有十分重要的意义。     

Bone scintigraphy in slipped capital femoral epiphysis

Tc-99m diphosphonate bone scans were performed on 11 children with slipped capital femoral epiphysis. On pinhole hip images, seven hips in seven patients had increased radionuclide uptake in the physis and adjacent proximal femoral metaphysis where the slip had occurred. Three hips in three patients had decreased radionuclide uptake in the femoral head on the side of the slipped epiphysis, indicating compromise of the femoral head blood supply. Three or more months following internal fixation, three children had scintigraphy that showed loss of the usual focal uptake in the physis and adjacent proximal femoral metaphysis. Bone scintigraphy in pediatric patients with slipped capital femoral epiphysis is valuable in defining the metabolic status of the femoral head. Absence of radiopharmaceutical uptake in the affected femoral head indicates that the femoral head is at risk for development of radiographic changes associated with aseptic necrosis.     

Age-related vascular changes in the epiphysis, physis, and metaphysis: normal findings on gadolinium-enhanced MRI of piglets

OBJECTIVE: We sought to study the normal enhancement patterns seen on MRIs of the epiphysis, physis, and metaphysis and age-related vascular changes in piglets using gadoteridol, a nonionic gadolinium chelate. MATERIALS AND METHODS: We quantitatively and qualitatively analyzed the normal changes on sequential T1-weighted images after the IV administration of gadoteridol. In an investigation approved by the research animal care committee at our hospital, we studied the proximal and distal femurs of 26 piglets 1-6 weeks old and correlated the enhanced images with findings on intermediate-weighted, T2-weighted, and gradient-recalled echo images and at histologic examination. RESULTS: We observed early enhancement of the epiphyseal vascular canals, the main physis, the physis of the secondary ossification center, and a metaphyseal band adjacent to the physis. Enhancement of the epiphyseal and metaphyseal marrow and of the epiphyseal cartilage was slower. In the epiphyseal cartilage, we saw three phases of enhancement: vascular, canalicular, and cartilaginous. As the piglets matured, enhancement of the epiphyseal cartilage decreased, and the epiphyseal vascular canals were less conspicuous. Physeal enhancement was greatest during the first week of life, declined at 3 weeks, and subsequently increased again as the physis came to lie adjacent to a larger segment of the epiphyseal ossification center. CONCLUSION: Gadoteridol-enhanced MRIs showed multiple cartilaginous and vascular structures of the growing skeleton. With maturity and progressive epiphyseal ossification, epiphyseal cartilage enhancement decreased, and physeal cartilage enhancement increased.