继发性甲旁亢锁骨下缘的骨吸收

笔者在随机选择５０例慢性肾衰患者的胸部Ｘ线片中，发现锁骨外１／３下缘韧带下骨吸收１２例，发生率为２４％，其发生率随血液透析（简称血透）时间的延长而增加。指出，此部位的骨吸收是继发性甲状旁腺机能亢进（简称甲旁亢）的重要Ｘ线征象。为了更好地识别早期骨吸收改变，笔者观察了１００例正常锁骨的Ｘ线局部解剖，并进行分型。     

肾性骨病的骨膜下骨吸收

笔者采用手骨直接Ｘ线放大摄影和双手Ｘ线平片来研究慢性肾衰血透病人５１例。特征性的指骨骨膜下吸收放大摄影发现２５例占４９％;平片为１１例占２１．６％,结果表明,放大摄影的阳性率明显高于平片（Ｐ＜０．００５）,骨膜下吸收的二,三指中间指骨桡侧及指骨末端是肾性骨病的“靶区”,认为二者无显著差异（Ｐ＞０．５０）。骨膜下吸收还与血透时间,血磷,血钙和碱性磷酸酶水平相关。     

继发性甲旁亢甲粗隆骨膜下骨吸收的X线观察

笔者采用指骨Ｘ线直接放大摄影来观察３０例甲粗隆的Ｘ线解剖和２４例肾性骨病甲粗隆骨膜下骨吸收的Ｘ线征象。认为甲粗降骨膜下骨吸收是肾性骨病继发性甲状旁腺机能亢进（甲旁亢）早期最敏感的Ｘ线征象。     

原发性甲旁亢的骨硬化

作者报告了1例原发性甲旁亢患者出现的骨硬化。男,38岁,持续性腰痛四年,向左大腿及膝部放射。实验室检查血钙升高,血磷降低,硷磷酶正常,肾功能正常,血清甲状旁腺素反复(182,213及206Pg/ml,正常为10-80Pg/ml)增高。头颅平片显示颅盖多发性局灶性骨硬化区,骨盆平片显示两侧髂翼及股骨头片状骨硬化,手部X线片未见     

长期血液透析治疗患者继发性甲旁亢性骨营养不良的X线诊断

作者报告25例慢性肾功能不全患者较长时间的血液透析治疗后,出现了继发性甲旁亢性骨营养不良,比较研究了Barnett 氏等1960年提出的第二掌骨骨干与皮质厚度比——周围指数方法观察骨质疏松同普通观察方法之间的差别。25例患者血液透析时间为2月～2年。化验检     

原发性甲旁亢的骨矿物含量变化

作者研究了34例原发性甲旁亢,以测定此病时的骨矿物质状况与生化数据(血清钙和甲状旁腺索)的关系、与外科治疗的关系、以及测定周围皮质骨与脊椎小梁骨之间的关系。分别对患者行掌骨r射线测定、桡骨Norland-Cameron光子吸收法、脊椎CT定量测定(QCT)、手的工业片摄影、胸腰段普通X线摄片。并根据胸腰段片测算了脊椎骨折指数。发现各种方法对四肢末稍骨的测量结果很一致,但与CT却不甚符合。脊椎骨折指数与QCT关系最大。此外,通常甲旁亢病人的末稍骨和中轴骨的矿物含量均有显著减少,不过,末稍     

左锁骨骨软骨瘤合并肺癌1例

1病例报告患者女,48岁。因左肩部肿物11年,隐痛2周就诊。否认肺结核等传染病及家族遗传病史,有吸烟史20余年。左锁骨上凹内2/3触及6·0 cm×7·0 cm大小包块,位置表浅、质硬,边界清晰、边缘凸凹不平,活动度小,压痛阳性,肿物表面皮肤颜色、皮温正常,无破溃。左侧腋窝区触及1·5 cm×1·5 cm肿大淋巴结,边缘光整可移动。左肩关节正位X线摄片:左锁骨内2/3区见5·8 cm×5·8 cm菜花样骨性肿块影,其内密度欠均匀,示骨皮质及少量骨小梁影,边缘清楚,左锁骨外1/3内侧缘骨质部分吸收、变薄,边缘清楚并稍有硬化,肿物向周边生长,相邻左侧第1肋骨及左肩胛骨内上部骨质局限吸收,边缘光整,左肩内上方软组织明显前移。另见左上肺内中带2·3 cm×2·5 cm不规则软组织肿块影,边缘有毛刺及胸膜凹陷征(与左上前外侧胸壁)。检送病理检查,证实为肺低分化腺癌。2讨论骨软骨瘤是常见良性骨肿瘤,由骨组织、软骨帽和纤维包膜等结构组成,肿瘤外为骨皮质、内为骨松质,均与母骨相连续,其顶端有软骨帽。其发病率占良性骨肿瘤的38·5%,占全部骨肿瘤的12·0%。本病可发生于任何软骨内化骨的骨骼上,好发于长骨干骺端,以股骨下端和胫...     

透析患者继发性甲旁亢性骨病X线平片及CT表现

目的 总结透析性骨、关节病不同部位的X线平片及CT表现.方法 20例患者分别进行X线平片和CT检查,检查部位包括肩、膝、髋、腕关节及颈椎.观察X线片和CT下透析性骨病的表现.结果 各关节在X线平片和CT上表现为骨密度减低(20例)、骨吸收(17例)、囊性骨损害(17例)、骨硬化(15例),软组织内转移性钙化(19例)等.结论 X线平片及CT诊断继发性甲旁亢性骨病具有较大优势.     

Imaging Findings Of Desmoplastic Fibroma Rarely Involving The Clavicle: Case Report

Desmoplastic fibroma of bone is a rare locally aggressive, but non-metastatic tumor. In this case report, we present a desmoplastic fibroma in an unusual location, the clavicle. Desmoplastic fibroma involving the clavicle is extremely rare, with only 2 reported cases before 1985. We report the imaging findings of a desmoplastic fibroma of the clavicle with a review of the relevant literature.     

巴戟天甲基异茜草素对破骨细胞性骨吸收的影响

目的研究甲基异茜草素抑制骨吸收的细胞学机制。方法采用原代培养的成骨细胞和骨髓单核细胞联合培养的方法,在1,25-（OH）2VitaminD3和地塞米松作用下,使骨髓单核细胞分化形成破骨细胞。磷酸苯二钠法测定破骨细胞抗酒石酸酸性磷酸酶（Tartrate-resistant acid phosphatase,TRAP）的活性;计算机图像分析技术测定骨片上破骨细胞性骨吸收陷窝的面积;荧光酶标方法测定组织蛋白酶K的活性。结果甲基异茜草素在0.1～10μmol·L^-1范围内,浓度依赖性地抑制破骨细胞形成、分化、TRAP酶活性和在骨片上形成的吸收陷窝的数目和面积。结论甲基异茜草素通过抑制破骨细胞的形成、分化和骨吸收功能来减少骨质的丢失。     

Bone loss in limbs with decreased or absent sensation: ten year follow-up of the hands in leprosy

Three hundred and sixty-seven patients with insensitive hands have been studied by correlating radiologic findings with occupational and medical history in order to better define causal factors in bone resorption. This study indicates that nonspecific infection and trauma are the reasons for bone resorption in 98% of cases. The role of intermittent pressure seems to be in soft tissue breakdown, which then allows bone to become infected. Bone resorption can be arrested at any stage of the disease by appropriate therapy of splinting and control of infection.     

Bone end sclerosis in renal osteodystrophy simulating osteonecrosis

Osteosclerosis of the bone ends is an unusual manifestation of renal osteodystrophy. In evaluating this finding one should be careful to exclude clinical and radiographic evidence for osteonecrosis. In the two known cases of this entity, bone end sclerosis has been found to develop over one to two years with symmetrical involvement of multiple bones.     

Bone age determination based on the study of the medial extremity of the clavicle

The development of the medial clavicular epiphysis and its fusion with the clavicular shaft have been a subject of medical research since the second decade of this century. Computed tomography provides the imaging modality of choice in analyzing the maturation process of the sternal end of the clavicle. In a retrospective study, we analyzed normal development in 380 individuals under the age of 30 years. The appearance of an epiphyseal ossification center occurred between ages 11 and 22 years. Partial union was found from age 16 until age 26 years. Complete union was first noted at age 22 years and in 100 % of the sample at age 27 years. Based on these data, age-related standardized age distributions and 95 % reference intervals were calculated. Compared to the experience recorded in the relevant literature, there are several landmarks that show no significant change between different ethnic groups and different periods of publication; these are the onset of ossification, the time span of partial union, and the appearance of complete union. Despite the relatively long time spans of the maturation stages, bone age estimation based on the study of the development of the medial clavicular epiphysis may be a useful tool in forensic age identification in living individuals, especially if the age of the subject is about the end of the second or the beginning of the third decade of life (e. g. in determining the applicability of adult or juvenile penal systems). Another possible use is in identifying human remains whose age is estimated at under 30 years. Received 31 December 1997; Revision received 11 February 1998; Accepted 23 February 1998     

Calcifying Aponeurotic Fibroma: A Multimodal Imaging Description of an Unusual Case Involving Soft Tissues Adjacent to the Clavicle

Calcifying aponeurotic fibromas (CAFs) are rare benign tumors that typically develop in the soft tissue of the extremities. We report a case of 64-year-old woman with a CAF in the soft tissue surrounding her left clavicle. A plain radiograph showed an asymmetrical increase in opacity of the left internal clavicular region. Computed tomography and magnetic resonance imaging confirmed the presence of a heterogeneous lesion of the periclavicular soft tissue, with peripheral calcifications, and remodeling of the adjacent clavicular bone. Following ultrasound-guided biopsy and surgical resection of the mass, the final histological diagnosis was made. To the best of our knowledge, this is the first case of a CAF described in the soft tissue adjacent to the clavicle. It is essential to use all the diagnostic methods available (X-ray, ultrasound, CT, MRI, and percutaneous biopsy) to obtain the final diagnosis of this rare disease.     

The skull in renal osteodystrophy

The skull radiographs of 68 patients undergoing dialysis for chronic renal failure were reviewed for evidence of renal osteodystrophy. Four patients (6%) were positive and the unusually severe changes seen in one patient are described in detail. The changes seen in the skull in renal failure, both before and after treatment, are discussed.