维生素D中毒骨内及脏器转移性钙化

目的：由于维生素Ｄ（简称ＶＤ）中毒引起骨质硬化的病理尚不明了，特此设计ＶＤ中毒实验病理研究。材料和方法：青紫蓝兔６６只。肌肉注射大、中、小剂量ＶＤ３。取上、下肢各大关节（包括骨干）、脊柱、肺、肾、胃进行Ｘ线照片和病理切片。结果：各部位骨骼髓腔、骨骺、干骺和关节软骨下均有不同程度硬化，还出现骨膜下吸收，骨皮质增厚，皮质骨松化，骨膜反应等。病理证实骨质硬化均为骨内转移性钙沉积。其机制是ＶＤ中毒引起成骨细胞和骨髓细胞坏死后钙化，轻者骨小梁表面钙沉积，重者钙化充满于松质骨的髓腔。停药后６～１２周观察，转移性钙化不能被吸收，而被新生骨包埋在骨内。结论：ＶＤ中毒骨质硬化是骨内转移性钙沉积所致     

读片窗

患者　男 ,33岁。左大腿疼痛 3个月 ,加重半个月入院。体检 :左大腿未见明显畸形 ,无红肿 ,触之皮温不高 ,左大腿中外侧骨质明显凸出伴压痛。尿本周氏蛋白阴性。Ｘ线平片示 :左股骨中段有一 6ｃｍ× 2ｃｍ× 3ｃｍ的骨质破坏区 ,局部骨髓腔扩大 ,边界清楚 ,层状骨膜增生 ,病变区未见死骨 (图 1)。ＣＴ平扫 :见扩大的骨髓腔内有软组织肿物及碎骨片 ,骨皮质厚薄不均 ,边缘凹凸不平 ,呈虫蚀样改变 ;骨膜增生较成熟 ,与骨皮质融为一体 (图 2 )。　　ＭＲＩ检查 :ＳＥ序列 ,Ｔ1ＷＩ上髓腔内病灶呈高、等、低混杂信号 (图 3) ;Ｔ2 ＷＩ上髓腔内病…     

马杜拉足的临床X线表现(附33例报告)

目的：探讨马杜拉足的临床Ｘ线表现以及与化脓性骨髓炎的区别。方法：收集马杜拉足３３例，分析其临床Ｘ线表现，对比左右两足在骨受累类型、分布以及Ｘ线表现上的差异。结果：临床特征有青年好发（２８．６岁），慢性病程（４５月），足部软组织肿胀和疼痛（２９例），皮肤糜烂、溃疡及反复流脓（１６例）。Ｘ线特征有跖骨和楔骨最常受累，以多骨受累为主，主要征象为骨质破坏（２８例）、软组织肿胀（２２例）、骨质硬化（１５例）、骨膜反应（８例）、骨干增粗和皮质增厚（７例），上述表现常合并存在。左足多骨受累多见，右足单骨受累多见，但左右两足之间在Ｘ线表现上无明显差异。结论：虽然马杜拉足的Ｘ线表现与慢性化脓性骨髓炎相似，但它们各有其不同的特征     

骨盆畸形致髂骨致密性髂骨炎样改变(附小儿麻痹后遗骨盆畸形160例分析)

目的：探讨骨盆畸形后髂骨致密性髂骨炎样改变的原因。材料与方法：分析了１６０例小儿麻痹后遗骨盆畸形的骨盆Ｘ线片及其中２例的骨盆ＣＴ片，另８５例正常人作对照。结果：小儿麻痹组５７例一侧，１例两侧共５８例有致密性髂骨炎样改变（３６．３％），正常组亦有２例（２．３％）。骨盆ＣＴ示上述致密改变是骶髂关节髂骨面中前部的骨质增多、增厚，致正常小三角形致密影明显增大，而骨质正常。结论：本组病例的致密性髂骨炎样改变是小儿麻痹后遗骨盆畸形向一侧偏歪、负重，骨盆力学结构变化，骨质按力学的Ｗｏｌｆｆ定律增生形成的一种Ｘ线征象     

蜡泪样骨病1例报告

蜡泪样骨病又称肢骨纹状增生症、单肢型骨质增生症、Peri病。本病为一种罕见的骨质硬化性疾病 ,我们遇到 1例 ,现报告如下。1　病例介绍患者 ,男 ,2 0岁 ,学生 ,以右踝外伤 1h之主诉来我院就诊。体检 :双下肢对称 ,右下肢皮肤无肿、热及颜色改变 ,右髋及膝关节活动正常 ,右踝关节活动受限 ,软组织肿胀。2　X线检查右股骨及胫腓骨皮质条状增生 ,呈斑点、片状高密度骨质硬化 ,骨皮质增厚 ,骨髓腔变窄 ,右足距骨、楔骨、骰骨内见团块、结节状骨质增生、硬化 ,骨轮廓无明显改变。各关节面光滑 ,关节间隙无狭窄 ,增生的骨质与正常骨质界线清晰 (…     

长骨溶骨型骨巨细胞瘤的X线诊断

目的：探讨长骨溶骨型骨巨细胞瘤的Ｘ线特征。方法：回顾分析了２２例经手术及病理证实的长骨溶骨型骨巨细胞瘤的Ｘ线征像。结果：（１）２２例均有不同程度的骨端松质骨破坏,破坏形态均趋于类球状,１０例侵及关节面。（２）骨皮质破坏１９例。（３）局限性骨膜反应４例。结论：长骨溶骨型骨巨细胞瘤的特征Ｘ线表现为骨端松质骨溶骨性骨质破坏,破坏形态趋于类球状,骨膜反应少见     

骨雅司病的临床及X线诊断

目的探讨骨雅司病的临床及X线特点。方法对12例骨雅司病临床与X线片表现进行分析总结，结合有关文献进行讨论。结果Ⅱ期雅司病9例，四肢皮肤多发对称或不对称丘疹及小结节，伴全身中毒症状。Ⅲ期3例，四肢皮肤及深层组织多发褐色脓疮，溃疡上下方环行排列多个杨梅大小结节。9例Ⅱ期雅司侵及骨骼，以骨膜、骨质增生为主。3例Ⅲ期雅司病，骨质增生同时伴骨质破坏。结论该病X线特点：（1）多骨受累；（2）病变主要在长骨骨干；（3）局限性不规则状骨膜骨皮质增生，骨髓腔模糊或消失；（4）弥漫性长骨骨硬化，伴骨皮质穿凿样破坏及松质骨虫蚀样破坏；（5）病变骨没有死骨形成。     

左胫骨Paget's病一例

患者　男,５２岁。左侧小腿疼痛１０余年,弯曲变形８年,近１０余天感觉疼痛加剧来院就诊。查体：左侧小腿向前外弯曲,胫骨前缘因前突而明显变尖,局部无红肿,皮肤温度不高。实验室检查：碱性磷酸酶１５０Ｕ／Ｌ（ＡＬＰ、ＫＩＮ法３０℃）,血清钙、磷正常,血沉８ｍｍ／ｈ,血常规正常。Ｘ线平片示：左侧胫骨中上段骨干增粗,向前向外弯曲、侧凸,骨皮质变厚,骨质密度不均,大部分骨皮质为紊乱、松变的板层骨所代替。骨皮质及骨髓腔内均见有广泛的、不规则的骨质破坏与骨质硬化相间存在,部分呈蜂窝状,胫骨上端骨松质内见有粗大的骨…     

X线片图像分析骨折后股骨头坏死的病理改变

目的：探讨Ｘ线片图像分析股骨颈骨折、头缺血坏死的病理基础。方法：对１０例股骨颈骨折（７例新鲜，３例陈旧）术前Ｘ线片股骨头进行图像分析，然后行人工关节置换，将取出之头行病理检查。结果：（１）１０例骨折Ｘ线片股骨头图像分析均为异常图像。（２）７例新鲜骨折的头内有出血，缺血坏死；陈旧３例骨折，除缺血坏死外，有不同程度血管增生及修复改变。结论：股骨头Ｘ线片图像分析异常图像的病理基础为头缺血坏死及髓腔出血     

腰椎后上缘软骨结节：附10例分析

笔者分析了１０例较为少见的腰椎后上缘软骨结节的临床、Ｘ线及ＣＴ表现。典型的改变为：（１）椎体后上缘类圆形骨质缺损，边缘致密硬化：（２）缺损后方有一骨块突入椎管（游离或部分与椎体相连）；（３）硬膜囊及神经根受压，可伴有椎间盘突出。对发生于椎体后上、下缘的软骨结节的发病机理做了探讨并比较了二者影像学上的异同。     

髓腔超扩Ⅰ期植骨封闭治疗全骨干骨髓炎

目的 探讨全骨干骨髓炎的治疗方法及效果。方法 对13例患者股骨（8例）或胫骨（5例）全骨干骨髓炎采用髓腔超扩Ⅰ期植骨封闭方法进行治疗。结果 12例治疗成功。1例失败。结论 髓腔超扩植骨封闭方法治疗全骨干骨髓炎是可行的，可以获得较高的成功率。     

骨良性纤维病变的影像与病理学分析

目的 提高对骨内良性纤维性病变的影像诊断和鉴别诊断能力. 资料与方法 对96例纤维性骨皮质缺损(FCD)、非骨化性纤维瘤(NOF)、骨化性纤维瘤(OF)和骨纤维异常增殖症(FD)患者的临床、影像学和病理学资料进行比较分析. 结果 FCD和NOF均好发于膝周骨,病理均为无成骨的纤维组织,X线和CT上表现为局限于皮质内和皮质内偏心性膨胀累及髓腔的均匀软组织密度影,MRI上主要为等T1、等T2异常信号.OF和FD病理表现交叉重叠,但OF中成骨细胞镶边现象明显多于FD.OF常见于颅面骨髓腔和胫骨前侧皮质下,表现为单骨内边界清楚的膨胀性不均匀钙质样密度.FD表现为单骨局灶性、弥漫性或多骨囊状膨胀性磨玻璃样改变,MRI上主要为等T1信号,等高混杂T2信号,局灶性FD边缘清楚伴有硬化边,弥漫性FD边界不清. 结论 FCD和NOF因具有相同的好发部位和组织学表现而可将影像学上病变局限于骨皮质者视为FCD,膨胀侵及髓腔者视为NOF.OF和FD的影像学鉴别点在于病变部位、边界和累及范围.     

长骨血管瘤的影像诊断

目的 分析长骨血管瘤的影像特征,旨在提高其诊断水平.方法 回顾性分析经手术病理证实的18例长骨血管瘤患者的X线平片(14例)、CT(9例)及MRI(6例).结果 18例长骨血管瘤中髓型10例、骨膜型5例、皮质内型3例.X线表现:髓型8例,其中3例表现为典型的蜂窝状,3例为溶骨性病灶周围骨质硬化明显,单纯溶骨、毛玻璃样密度各1例;骨膜型3例,表现为骨皮质增厚、硬化;皮质内型3例,表现为边界清晰的溶骨性病灶.CT表现:髓型6例,表现为溶骨膨胀型病灶5例,其中3例可见薄厚不一的硬化边,蜂窝状骨嵴影2例,骨皮质呈筛孔状1例,垂直于骨皮质的放射状骨膜增生2例;毛玻璃样密度1例.2例骨膜型表现为骨皮质均匀增厚1例,不规则骨膜增厚1例,局部髓腔狭窄消失.1例皮质内病变表现为病灶呈均匀软组织密度,局部皮质膨胀、增厚.MRI表现:2例显示髓腔内斑片状T1WI稍低信号,T2WI均呈稍高信号,边界清晰;1例T1WI及T2WI均呈等或稍低信号,病灶与正常组织分界不清;1例显示病灶突破局部骨皮质,肿物向外突出,外突肿物及相连髓腔部分T1WI呈稍低信号,T2WI呈高信号;2例显示骨膜增厚,其中1例呈等信号,1例无信号;2例周围肌肉组织内可见不均匀斑片状长T2信号,T1WI与肌肉组织呈等信号.结论 长骨血管瘤的囊性蜂窝状X线表现较为特征型;CT及MRI有助于长骨血管瘤的诊断.     

长骨血管瘤的影像诊断

目的 分析长骨血管瘤的影像特征,旨在提高其诊断水平.方法 回顾性分析经手术病理证实的18例长骨血管瘤患者的X线平片(14例)、CT(9例)及MRI(6例).结果 18例长骨血管瘤中髓型10例、骨膜型5例、皮质内型3例.X线表现:髓型8例,其中3例表现为典型的蜂窝状,3例为溶骨性病灶周围骨质硬化明显,单纯溶骨、毛玻璃样密度各1例;骨膜型3例,表现为骨皮质增厚、硬化;皮质内型3例,表现为边界清晰的溶骨性病灶.CT表现:髓型6例,表现为溶骨膨胀型病灶5例,其中3例可见薄厚不一的硬化边,蜂窝状骨嵴影2例,骨皮质呈筛孔状1例,垂直于骨皮质的放射状骨膜增生2例;毛玻璃样密度1例.2例骨膜型表现为骨皮质均匀增厚1例,不规则骨膜增厚1例,局部髓腔狭窄消失.1例皮质内病变表现为病灶呈均匀软组织密度,局部皮质膨胀、增厚.MRI表现:2例显示髓腔内斑片状T1WI稍低信号,T2WI均呈稍高信号,边界清晰;1例T1WI及T2WI均呈等或稍低信号,病灶与正常组织分界不清;1例显示病灶突破局部骨皮质,肿物向外突出,外突肿物及相连髓腔部分T1WI呈稍低信号,T2WI呈高信号;2例显示骨膜增厚,其中1例呈等信号,1例无信号;2例周围肌肉组织内可见不均匀斑片状长T2信号,T1WI与肌肉组织呈等信号.结论 长骨血管瘤的囊性蜂窝状X线表现较为特征型;CT及MRI有助于长骨血管瘤的诊断.

Abstract：

Objective To explore the imaing features of hemangioma in the long bone and improve the diagnostic level of this disease. Methods The X-ray(14 cases), CT(9 cases) and MRI(6 cases)findings of 18 patientswith histologically proven hemangioma in the long bone after surgery were retrospectively reviewed. Results Ten tumors occurred in medullary cavity or bone end(medullary type),6 on the surface of bone (periosteal type) and 3 in cortex (intracortical type). X-ray findings: among 8 cases of medullary type, 3 showed honeycomb appearance, 3 lytic areas with sclerotic borders, one purely osteolyticchanges, and 1 frosted glass; 3 cases of periosteal type showed sclerosis and thickening of the underlying cortex; 3 cases of intracortical type showed well-defined osteolytic foci. CT findings: among 6 cases of medullary type, 5 appeared as expansile lytic lesion with uneven selerotic rim (3 cases)orhoneycomb appearance (2 cases), 1 cribriform appearance in the cortical bone, 2 periostealnew bone formation in vertical radiation pattern; 1 ground-glass appearance; among 2 cases of periosteal typeone showed regular cortical thickening, and the other irregular periosteal proliferation with marrowing of medullarycavity; 1 case of intracorticaltype showed density similar to that of soft tissue, with cortical thickening and expansion . MRI findings: 2 apeared as well-defined lesions with low signal intensity on T1WI and high signal intensity on T2WI; 1 appeared as ill-defined lesion with low to intermediate signal intensity on T1 WI and T2 WI. One showed breakthrogh of cortex and formation of soft tissue mass with low signal intensity on T1 WI and high signal on T2WI. Two showed thickening of periosteumwith intermediate signal intensity in one of them and very low signal intensity in the other. Two showed abnormal signal intensity in surrounding muscles, which was high on T2 WI and intermediate on T1 WI. Conclusions The soap-bubble or honeycomb appearance is the typical radiographic finding of hemangioma in long bone. CT and MRI can provide useful information for the diagnosis of hemangioma in long bone.     

长骨血管瘤的影像诊断

目的 分析长骨血管瘤的影像特征,旨在提高其诊断水平.方法 回顾性分析经手术病理证实的18例长骨血管瘤患者的X线平片(14例)、CT(9例)及MRI(6例).结果 18例长骨血管瘤中髓型10例、骨膜型5例、皮质内型3例.X线表现:髓型8例,其中3例表现为典型的蜂窝状,3例为溶骨性病灶周围骨质硬化明显,单纯溶骨、毛玻璃样密度各1例;骨膜型3例,表现为骨皮质增厚、硬化;皮质内型3例,表现为边界清晰的溶骨性病灶.CT表现:髓型6例,表现为溶骨膨胀型病灶5例,其中3例可见薄厚不一的硬化边,蜂窝状骨嵴影2例,骨皮质呈筛孔状1例,垂直于骨皮质的放射状骨膜增生2例;毛玻璃样密度1例.2例骨膜型表现为骨皮质均匀增厚1例,不规则骨膜增厚1例,局部髓腔狭窄消失.1例皮质内病变表现为病灶呈均匀软组织密度,局部皮质膨胀、增厚.MRI表现:2例显示髓腔内斑片状T1WI稍低信号,T2WI均呈稍高信号,边界清晰;1例T1WI及T2WI均呈等或稍低信号,病灶与正常组织分界不清;1例显示病灶突破局部骨皮质,肿物向外突出,外突肿物及相连髓腔部分T1WI呈稍低信号,T2WI呈高信号;2例显示骨膜增厚,其中1例呈等信号,1例无信号;2例周围肌肉组织内可见不均匀斑片状长T2信号,T1WI与肌肉组织呈等信号.结论 长骨血管瘤的囊性蜂窝状X线表现较为特征型;CT及MRI有助于长骨血管瘤的诊断.     

Fat within the falx: MR demonstration of falcine bony metaplasia with marrow formation

Falcine bony metaplasia frequently is incorrectly labeled "dense calcification" on brain CT and conventional radiography. Of 3,000 brain magnetic resonance (MR) scans reviewed, 12 demonstrated a central area of increased signal intensity on T1 and T2 weighted images with a smooth peripheral rim of diminished signal intensity within the region of the falx. The central area of increased signal intensity corresponded to fat in the medullary cavity and the peripheral area of low signal intensity corresponded to cortical bone. The CT scans, available in nine of 12 patients, were compared with the MR scans and revealed dense mineralization in the corresponding region of the falx. A postmortem specimen of densely "calcified" falx cerebri was examined that revealed cortical bone and a medullary cavity complete with bony trabeculae and marrow. The MR findings of falx ossification should not be confused with other entities of greater clinical significance.     

MR imaging features of bizarre parosteal osteochondromatous proliferation of bone (Nora's lesion)

The purpose of this study was to review the imaging findings of three patients with bizarre parosteal osteochrondromatous proliferation of bone (BPOP). The plain radiographs and MRI images of three patients with BPOP were obtained and retrospectively reviewed. In two cases, BPOP involved the feet. In one case BPOP involved the hand. In all three cases, plain radiographs showed a well-defined calcium containing mass adjacent to the cortical surface of the adjacent bone. The underlying bone appeared normal in all cases. On MRI, the lesion was of low signal intensity on T1 weighted sequences in all cases. On FSE T2 weighted and STIR sequences, the lesion was of high signal in all cases. The cortex, medullary cavity and adjacent soft tissues appeared normal in all cases. While BPOP is rare and often confused with a variety of both benign and malignant lesions, there are specific radiological findings that may help to distinguish BPOP from many of its mimickers.     

Tumor infiltration of the bone marrow: Comparative study using computed tomography

During the past two years five patients with malignant primary bone tumors undergoing amputation or resection of the involved bone had preoperative computed tomography (CT) examination of the medullary cavity. The contralateral extremity was used as a control in all cases. The positive attenuation coefficient of the marrow indicated the extent of tumor infiltration. The correlation between the preoperative CT and pathologic measurement ranged between 1–8 mm, an accuracy greater than 94%.     

FixionTM可膨胀髓内钉系统应用于长骨骨折的临床分析

目的探讨迪索泰（Fixion^TM）可膨胀髓内钉系统在长骨骨折中的应用价值与技术特点。方法随机选取四肢长骨骨折病例21例,应用Fixion^TM系统内固定,术后评定骨折愈合情况与患肢功能。结果术后随访2～18个月,21例均达到骨折愈合,Johner—Wruhs评分优良率85．7％。结论Fixion^TM可膨胀髓内钉系统操作方法简捷,具有良好的髓腔适配,可以采用微创侵入方式,实现骨折快速稳定的髓内固定,临床治疗长骨骨折预后良好。     

Magnetic resonance imaging of the normal bone marrow

The bone marrow is a complex organ that contains fat and nonfat cells, the proportions of which vary greatly with age and in the different bones of the skeleton. Magnetic resonance (MR) imaging provides information on the composition of the medullary cavity of any given bone and on the distribution of red and yellow marrow in the skeleton. This article deals with the wide spectrum of appearances of the normal bone marrow at MR imaging.