骨骼系統(tǒng)常見病的影像診斷pt課件

1、典型的olliers病 ：（多發(fā)內(nèi)生性軟骨瘤伴軟骨發(fā)育障礙、肢體畸形），軟組織（無明顯腫脹）內(nèi)未見靜脈石 從正位片可以診斷嗎？本例骨折機制是什么？復(fù)雜部位可疑骨折宜選復(fù)雜部位可疑骨折宜選ctm，23y，右小腿下部疼痛3周起病1周時照片化膿性骨髓炎sequestrum骨關(guān)節(jié)結(jié)核骨關(guān)節(jié)結(jié)核(tuberculosis of bone and joint)以骨質(zhì)破壞、骨質(zhì)疏松、軟組織腫脹為以骨質(zhì)破壞、骨質(zhì)疏松、軟組織腫脹為主的慢性病主的慢性病系繼發(fā)性結(jié)核，系繼發(fā)性結(jié)核，95%以上繼發(fā)于肺結(jié)核以上繼發(fā)于肺結(jié)核椎體、干骺端、關(guān)節(jié)滑膜為好發(fā)部位椎體、干骺端、關(guān)節(jié)滑膜為好發(fā)部位好侵犯軟骨，可合并冷性膿腫好侵犯

2、軟骨，可合并冷性膿腫未合并感染時骨質(zhì)增生不明顯未合并感染時骨質(zhì)增生不明顯骨膜反應(yīng)輕微，死骨為砂粒樣骨膜反應(yīng)輕微，死骨為砂粒樣骺、干骺端為好發(fā)部位，骨干結(jié)核少見骺、干骺端為好發(fā)部位，骨干結(jié)核少見表現(xiàn)：骨松質(zhì)類圓形骨質(zhì)破壞，無骨質(zhì)增生，少骨膜反表現(xiàn)：骨松質(zhì)類圓形骨質(zhì)破壞，無骨質(zhì)增生，少骨膜反應(yīng)，碎屑狀（泥沙）死骨；骨質(zhì)疏松，易累及骨骺、關(guān)應(yīng)，碎屑狀（泥沙）死骨；骨質(zhì)疏松，易累及骨骺、關(guān)節(jié)，不易向骨干發(fā)展。節(jié)，不易向骨干發(fā)展。localized bone destruction in the epiphysis or metaphysis. lack of new bone formation an

3、d periosteal reaction. small sand-like sequestrumquite in contrast to that of pyogenic infection. as this disease progresses, it has a tendency to break through the epiphysis to involve the joint . it may break through the cortex, periosteum and invade the sorrounding soft tissue forming a fistula.

4、急性化膿性骨髓炎與結(jié)核鑒別診斷急性化膿性骨髓炎與結(jié)核鑒別診斷化膿性骨髓炎與結(jié)核死骨的比較化膿性骨髓炎與結(jié)核死骨的比較短骨骨干結(jié)核短骨骨干結(jié)核tuberculosis of the shaft of the short bones 骨質(zhì)疏松，囊性破壞，皮質(zhì)變薄骨質(zhì)疏松，囊性破壞，皮質(zhì)變薄 骨干膨脹，骨骨干膨脹，骨“氣鼓氣鼓”長骨骨干結(jié)核長骨骨干結(jié)核tuberculosis of the shaft of the long bones 少見，骨質(zhì)破壞，增生不明顯少見，骨質(zhì)破壞，增生不明顯 可輕度骨膜反應(yīng)可輕度骨膜反應(yīng)骨干結(jié)核骨干結(jié)核tuberculosis of the shaft 骨型關(guān)節(jié)結(jié)核骨

5、型關(guān)節(jié)結(jié)核: 骺、干骺端結(jié)核征象骺、干骺端結(jié)核征象關(guān)節(jié)周圍軟組織腫脹關(guān)節(jié)周圍軟組織腫脹關(guān)節(jié)間隙不對稱狹窄關(guān)節(jié)間隙不對稱狹窄關(guān)節(jié)骨質(zhì)破壞關(guān)節(jié)骨質(zhì)破壞osseous type: it may be a secondary extension of tuberculous infection from the adjacent epiphysis or metaphysis, and more commonly occur in adult.關(guān)節(jié)結(jié)核關(guān)節(jié)結(jié)核(tuberculosis of joints)脊椎結(jié)核與轉(zhuǎn)移瘤的鑒別骨腫瘤：影像診斷的要求骨腫瘤：影像診斷的要求1.是否為骨腫瘤是否為骨腫瘤2

6、.判斷良、惡性判斷良、惡性3.原發(fā)性、轉(zhuǎn)移性原發(fā)性、轉(zhuǎn)移性4.侵犯范圍侵犯范圍5.推測組織學(xué)類型推測組織學(xué)類型giant cell tumour:the end of long bones osteosarcoma:metaphysis of long bones metastasis:spine & flat bones （脊椎和扁骨）monostotic:primary polyostotic: myelomas & metastases permeative:malignancyexpansive:benignosteochondroma:expansive/osteosclerosis osteosarcoma: destruction成骨型骨肉瘤codmans triangle absence:benignabsence:benignmass:malignancyt1wit2wistir 生長快的骨腫瘤較易在骨外軟組織內(nèi)形成腫塊病變，常見于惡性骨腫瘤，惡性骨腫瘤軟組織腫塊亦具有腫瘤本身的所有特征，注意分析軟組織腫塊的影像特征對影像診斷具有重要價值。mri對軟組織內(nèi)腫塊的顯示明顯優(yōu)于平片f26ygiant-cell tum