继发性甲旁亢的锁骨骨吸收

１８例慢性肾衰继发性甲旁亢病人发现有锁骨骨吸收。发病部位包括锁骨内端、外端、外１／３下缘及内段下缘４个部位。其中锁骨内、外端骨吸收属软骨下骨吸收，内、外段下缘骨吸收属韧带下骨吸收。作者对锁骨骨吸收的Ｘ线表现及发病机制作了讨论。认为锁骨骨吸收是继发性甲旁亢的重要Ｘ线征象，对诊断肾性骨病具有重要的意义。     

肾性骨病核素骨显像结果分析

目的 探讨99Tcm-亚甲基二磷酸盐(99Tcm-MDP)骨显像在肾性骨病中的应用价值.方法 选择我院2008～2011年经过确认的肾性骨病36例,行核素SPECT显像,分析其影像学表现.结果 10例双侧胫腓骨摄取增加;8例双下肢骨、6例全身长骨骨摄取不均匀;5例全身关节膨大,双侧肱骨、股骨弯曲畸形;6例全身关节膨大伴周围软组织钙化;1例全身关节膨大伴全身多处软组织包块.结论 结合临床资料,99Tcm-MDP骨显像能准确判断病变性质,可为肾性骨病的诊治提供有力依据.     

肾性骨病一例

肾性骨病又称肾性骨营养不良,是各种慢性肾脏疾病所引起的钙、磷代谢障碍、酸碱平衡失调、维生素D代谢异常及继发甲状旁腺机能亢进等所造成的骨骼损害.在儿童期称为肾性佝偻病,成人期称为肾性软骨病[1].目前,肾性骨病发病率未见明确统计.     

影响骨膜成骨的因素

影响骨膜成骨的因素１０００３７北京解放军第３０４医院李利综述朱盛修审校中国图书资料分类号Ｒ６８１．１自１７３９年Ｄｕｈａｍａｌ提出骨膜成骨理论以来,各国学者进行了大量的实验研究与临床应用。现就影响骨膜成骨的主要因素加以分析。１解剖本世纪６０年代的许多...     

树脂吸附联合血液透析治疗血透病人的肾性骨病

目的观察树脂吸附联合血液透析对慢性肾功能衰竭维持性血液透析患者肾性骨病的治疗效果。方法选取2004年1月至2006年10月维持性(2年以上)血液透析患者52例,分为三组:A组为树脂吸附加血液透析组(HP+HD);B组为血液透析滤过组(HDF+HD);C组为口服活性维生素D组(口服活性维生素D+HD)。比较三组治疗前后患者血甲状旁腺素(iPTH)及血磷的变化,以及尿素氮(BUN)、血肌酐(Scr)、血红蛋白(Hb)的变化。结果三组治疗前后相比,BUN、SCr、Hb差别无显著性,三组之间相比差别也无显著性。与治疗前相比,治疗12周后,A组患者iPTH及血磷明显下降(P<0.05),48周后A组、B组iPTH及血磷均明显下降(P值分别为P<0.01及P<0.05)。三组之间相比,治疗48周时A组iPTH及血磷比其他两组更低(P<0.05)。A组患者血甲状旁腺素及血磷的清除明显好于B组和C组。结论树脂吸附联合血液透析对慢性肾功能衰竭维持性血液透析患者肾性骨病的治疗是有效的。     

Severe erosive arthritis of large joints in chronic renal failure

Two cases of chronic renal failure are presented in which a large joint severe erosive arthritis was the prominent radiologic feature of their renal osteodystrophy. In one both knees were involved, and in the other both knees and one wrist. Distal clavicular erosions were present in both, but hands were not radiographically involved. The literature is reviewed in regards other reports of erosive arthritis complicating renal failure.     

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。     

眼眶骨膜下间隙血肿的CT、MRI表现

目的分析眼眶骨膜下间隙血肿的CT、MRI表现并探讨其临床价值。资料与方法36例（36眼）眼眶外伤性骨膜下血肿患者中,同时行眼眶CT、MRI检查2例。仅行眼眶CT检查30例．横断位、冠状位检查25例,横断位1例,冠状位检查4例。仅行MRI检查4例。结果跟眶CT显示骨膜下间隙血肿32例,其中上壁18例,外上壁7例,外壁5例,下壁2例。病变广基附于眶壁,内缘清楚,密度均匀,一般不跨越骨缝。眼眶MRI显示上壁骨膜下间隙血肿6例,信号取决于出血时间。结论眼眶骨膜下间隙血肿多发生于眼眶上壁。CT、MRI有助于对该病的诊断及鉴别诊断。     

Growth plate injury of the hand and wrist in renal osteodystrophy

We present two cases of growth plate injury of the hand and wrist in young patients with renal rickets and osteodystrophy but no history of antecedent trauma. The postulated mechanism of injury is subclinical biomechanical stress on the involved extremity superimposed on the already weakened metaphysis and growth plate. Thus, the findings may be viewed as an insufficiency injury to the metaphysis and growth plate. Physicians should be aware that, in the absence of unusual athletic activity, epiphysiolysis of the upper extremity is uncommon and requires a search for underlying metabolic bone disease.     

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。     

Distal phalangeal brachydactyly secondary to healed renal osteodystrophy

Six cases of distal phalangeal brachydactyly of the hands in patients with healed renal osteodystrophy are reported. Severe osseous changes of renal osteodystrophy were seen in all cases. These cases present healed renal osteodystrophy as another consideration in the differential diagnosis of distal phalangeal brachydactyly.     

Shoulder erosions in renal osteodystrophy

The radiographic manifestations of renal osteodystrophy may be articular as well as osseous. The latter are well recognized, i.e., subperiosteal and subchondral bony resorption. Recently attention has been directed to the occurrence of an erosive arthritis of the hands and wrists in hyperparathyroidism. The authors present six patients with humeral head erosions, all of whom were on chronic long-term hemodialysis. These intra-articular erosions occurred at the bare area of the humeral head and thus represent an erosive arthritis and therefore can be distinguished from the usual sites of subchondral and subperiosteal bony resorption seen in hyperparathyroidism.     

Metaphyseal sclerosis in patients with chronic renal failure

We reviewed radiographs of the hands and wrists of 33 patients with immature skeletons and chronic renal disease. Various radiographic manifestations of renal osteodystrophy were seen, including osteopenia in 23 patients (70%), subperiosteal resorption in 20 (61%), distal tuft resorption in 14 (42%), sclerosis of vertebral bodies in 2 (6%), and soft-tissue calcification in 1 (3%). We also noted that 13 patients (39%) exhibited metaphyseal sclerosis adjacent to the growth plates. Five of these 13 showed persistent sclerosis years after the growth plates had fused. None of the patients showed other radiographic changes of rickets, and there was no correlation between the serum calcium, phosphorus, or aluminum levels and the presence of metaphyseal sclerosis. Neither was there any association with the underlying cause of renal failure, method of treatment, presence of a transplant, or type of dialysis. We view this finding as another manifestation of renal osteodystrophy. The importance of distinguishing it from other sclerotic lesions is discussed.     

Periosteal resorption and periosteal neostosis: Comparison of normal subjects and renal failure patients on chronic ambulatory peritoneal dialysis using MOP-3 image analysis system and a grading method

This is the first known attempt to quantitate periosteal resorption (PR) and perisoteal neostosis (PN) by a semi-automatic image analysis system (Zeiss MOP-3). The normal ranges and errors for PR were found to be similar to those of a previous study using a measuring magnifier. The findings in chronic renal failure patients showed that MOP-3 measurements were actually diagnostically slightly less sensitive than the results by a simple grading method. Comparison with plasmaimmunoreactive parathyroid hormone (iPTH) concentrations showed that while the latter had a higher sensitivity for detection of hyperparathyroidism, the radiologic parameters nevertheless showed abnormal PR in 12% of the observations where iPTH was normal. Both PR and PN correlated significantly with iPTH (r=0.55 and 0.30 respectively, P<0.01).