多发性骨髓瘤的临床及X线分析

目的：提高对多发性骨髓瘤的认识和诊断水平，探讨其X线表现。方法：对15例经检查骨髓证实的病例，结合献，回顾分析其临床及X线表现。结果：多发性骨髓瘤主要征象为，①多发性骨破坏，呈圆形或类圆形透亮区，大小不等．可有软组织包块，多发生于扁骨及长骨近端。②病理骨折多发生于肋骨，长骨近端病变亦可发生病理骨折：③骨质疏松，多为周身性普遍性骨质疏松，表现为骨密度减低，骨皮质变薄，骨小梁纤细、模糊不清，可与多发骨破坏同时存在。此外，8例胸片发现肋骨破坏，余7例亦经X线检查发现不同程度的骨破坏经骨髓及周围血像中找到分化不好的浆细胞而确诊，其中7例本-周氏蛋白阳性。结论：多发性骨髓瘤X线检查具有重要意义，只要认真分析X线征象，密切结合临床及实验室检查、是能够及时准确做出诊断的，对一些不典型病例应提示临床多体位拍片，做一系列临床实验室检查，以排除骨髓瘤的可能性。

Clinical and X-ray analysis of multiple myeloma

Objective To analyze X- ray findings of multiple myeloma and to elevate the diagnostic level.Methods X- ray findings of 15 patients with clinically proved multiple myeloma were analyzed retrospectively.Resutls The main signs of multiple myeloma were:(1)multiple bone destruction appeared as round or oval lucent area,different size,and could had soft tissue mass,which was frequently found in flat bone and the proximal end of long bone.(2)pathologic fracture was maily found in costal bone but also found in the proximal end of long bone.(3)osteoporosis appeared as whole- length bone dense decreasing,bone cortex thinning,bony trabecula thinning and hazy or non- clear,and could associated with multiple bone destruction,in addition,8 patients were found to be costal bone destruction while other 7 patients were definitely diagnosed by X- ray examination found different degree of bone destruction and by peripheral blood test found low- differentiated plasmacytes.Conclusion X ray examination plays significant role in the diagnosis of multiple myeloma.If only care analyzing X- ray findings and close combining with clinical and laboratory tests,multiple myeloma is can definitely diagnosed but when the lesions are atypical the definite diagnosis needs clinical and laboratory examination so as obviating the possibility of myeloma. [