四肢骨影像学类死骨征象的临床意义分析

doi:DOI:10.12117/jccmi.2018.12.012

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摘要目的：研究影像学类死骨征象在四肢骨不同疾病中的出现率。方法：回顾分析四肢骨病变并有骨质破坏患者的资料，共253名患者13个病种，诊断均经病理或临床随访证实，均经CT检查，163例经平片检查，144例经MRI检查，三种检查齐全的共66例。在CT图像上观察病灶内此征象的出现情况，统计出现此征象的病种及出现率，用χ2检验进行统计分析。结果：92.3%（12/13）的病种和43.1％（109/253）的病例出现此征象。不同病种其出现率不同，骨髓炎为52.9%（27/51），骨结核为70.0%（7/10），骨转移瘤为47.1%（48/102），骨纤维异常增殖症为32.1%（9/28），骨巨细胞瘤为22.2%（6/27），骨结核中类死骨征象出现率最高（χ2=11.532，P<0.05），其次为骨髓炎和骨转移瘤。亦可出现于其他疾病中，Langerhans组织细胞增生症3例（3/8），淋巴瘤1例（1/6），恶性纤维组织细胞瘤2例（2/5），动脉瘤样骨囊肿3例（3/5），骨化性纤维瘤1例（1/8），骨血管肉瘤1例（1/1），纤维肉瘤1例（1/1），原始神经外胚层肿瘤0例（0/1）。结论：绝大多数有骨质破坏的四肢骨良恶性疾病中可不同比例的出现类死骨征象，在骨结核中出现率最高，其次为骨髓炎和骨转移瘤。应结合其它征象具体分析做出定性诊断以避免误诊。

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	张源
	陈海松
	冯卫华
	周锐志

关键词 ：骨疾病, 体层摄影术, X线计算机, 磁共振成像

Abstract：Objective: To study the differences of the occurrence rate of “sequestrum” sign in different diseases of extremity. Methods: Patients with limb bone diseases and bone destructive lesions in our hospital from 2008 to 2016 were retrospectively analyzed. Two hundred and fifty-three patients with 13 types of diseases that proved by pathology or clinical follow-up were included in the observation. CT examination was performed in all cases, radiography in 163 cases, MRI in 144 cases, and all the three kinds of examination was performed in 66 cases. CT images were used to observe the occurrence of the “sequestrum” sign and to calculate the occurrence rate of the sign. χ2 test was used to perform statistical analysis. Results: “Sequestrum” sign appeared in 92.3%(12/13) of the disease types and in 43.1%(109/253) of all the cases. But occurrence rate of “sequestrum” sign differed in different types of the disease, osteomyelitis 52.9%(27/51), skeletal tuberculosis 70.0%(7/10), metastatic carcinoma 47.1%(48/102), fibrous dysplasia 32.1%(9/28), and giant cell tumor of bone 22.2%(6/27). The occurrence rate was the highest in bone tuberculosis(χ2=11.532, P<0.05), followed by osteomyelitis and bone metastases. Other types with less cases also showed “sequestrum” sign, including 3 cases of Langerhans cell histiocytosis(3/8), 1 case of primary lymphoma of bone(1/6), 2 cases of malignant fibrous tumors(2/5), 3 cases of aneurysmal bone cyst(3/5), 1 case of osteofibrous dysplasia(1/8), 1 case of angiosarcoma of bone(1/1), and 1 case of fibrosarcoma of bone(1/1). The sign was not found in the only one case of primitive neuroectodermal tumor(PNET)(0/1). Conclusion: “Sequestrum” sign can be seen in vast majority of limb bone disease of benign and malignant bone destructive lesions, but it is seen in skeletal tuberculosis most commonly, followed by osteomyelitis and bone metastases. We should combine this sign with other signs to make qualitative diagnosis and avoid misdiagnosis.

Key words： Bone diseases Tomography, X-ray computed Magnetic resonance imaging

收稿日期: 2018-01-05

PACS:	Ｒ681
	Ｒ814.42
	Ｒ445.2

通讯作者: 陈海松，青岛大学附属医院放射科，266003。

作者简介: 张源（1990-），男，山东聊城人，医师。

引用本文:

张源，陈海松，冯卫华，周锐志. 四肢骨影像学类死骨征象的临床意义分析[J]. 中国临床医学影像杂志, 2018, 29(12): 884-888.
ZHANG Yuan, CHEN Hai-song, FENG Wei-hua, ZHOU Rui-zhi. The clinical significance of the sequestrum sign in limb bone imaging. JOURNAL OF CHINA MEDICAL IMAGING, 2018, 29(12): 884-888.

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http://www.jccmi.com.cn/CN/DOI:10.12117/jccmi.2018.12.012 或 http://www.jccmi.com.cn/CN/Y2018/V29/I12/884

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