Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2821_Библиотеки_им_академика_М_И_Перельмана
.pdf
https://t.me/medicina_free
FIGURE1-11.Imagingdemonstrationofneuropathic(Charcot)footonradiographsandoftheankleon
radiograph,CT,andMR.AP(A),lateral(B),andoblique(C)X-rayviewsoftherightfootdemonstrateextensive
Charcot-typearthropathicchangesatthetarsometatarsaljointswithbonedestruction,fractures,fragmentation,and
dislocations.Owingtosensorydeficienciesassociatedwiththeunderlyingdiabeticneuropathy,painisnotalways
https://t.me/medicina_free
present,sothepatientkeepsambulating,hencethelackofosteopeniaordensebones.X-ray(D),CT(E),andMR
(F)findingsinaneuropathicankle.D:LateralX-raydemonstratesfragmentationandcollapseofthetalusanddistal
tibia.Thereisahealingfractureofthedistalfibula.E:SagittalreformattedCTimageoftheankledemonstrates
markeddestructivearthropathywithmultifocalarticularsurfacelossandsubchondralcysts.F:Sagittalfastspin
echoprotondensity–weightedMRimagedemonstratesamarkedmultifocaldestructivearthropathythroughoutthe
articulationsofthemidfootandhindfootwithcollapseandfragmentationofthetalusanddisorganizationoftheankle
joint.
FIGURE1-12.RadiographicpresentationofmultipleEnchondromas.APradiographoftheleftfoot
demonstratesmultipleintramedullary,expansive,osteolyticlesionswithinthemetatarsalsandphalanges,most
evidentinthe2ndto4thproximalphalanges.Amoreeccentriclesionisseenalongthelateraldistalcortexofthe3rd
metatarsal.The2ndand5thmetatarsalsareshortsecondarytogrowthdisturbancefromtheenchondromas.
OSTEOGENESISIMPERFECTA
Osteogenesis imperfecta (OI) is a congenital, non–sex-linked hereditary disorder of the
connective tissue. The disease is commonly separated into four distinct subtypes (I to IV)
basedonseverityandclinicalfindings,withtypeIIresultinginperinataldemise.25Theusual
musculoskeletalpresentationisfrequentfracturesfromexcessivebonemalleabilitysecondary
to the inherent lack or abnormality of type1 collagen.26 The radiographic features include
osteopenia,multiplefractures,andbonydeformitiesincludinggracilebonesandbowing.26The
fracturesmostcommonlyoccurinthediaphysisoflongbonesandthespine.26Themainstayof
https://t.me/medicina_free
treatmentiswithbisphosphonates,whichcanresultindensemetaphysealbands(Fig.1-13).
26
OSTEOPETROSIS
Osteopetrosis (Albers-Schönberg disease) is a rare hereditarydisorder inwhich there is a
genetic defect of osteoclast function.27 There are bothautosomal dominant (adulttype) and
autosomal recessive (infantile type) forms of the disease, with the latter often resulting in
intrauterineorearlydemise.28Thetypicalradiographicappearanceisthatofdensemedullary
cavitysclerosisthatisclassicallydescribedtohavea“bonewithinboneappearance.”Other
typical findingsare Erlenmeyer flaskdeformities oftubularbones and“sandwichvertebra,”
wherethereisdensesclerosisoftheendplates.Manypatientsarecompletelyasymptomatic,
withaminoritypresentingwithanemiaandpathologicfracturesowingtothefragilenatureof
theabnormalbone(Fig.1-14).
28
https://t.me/medicina_free
https://t.me/medicina_free
FIGURE1-13.TwoexamplesofOIindifferentpatients.A:Lateralviewoftheankledemonstratesanterior
bowingoftibiaandahealingfractureintheposteriortibialcortex.B:APradiographofthelowerextremitiesinthis3-
year-oldchildwithOIdemonstratesdiffuseosteopenia,gracilebones,bowingdeformities,andmultiplehealing
fracturesofthemid-todistaldiaphysisoftheleftfemurandthemidshaftoftherightfibula.Notethedense
metaphysealbandsatthedistaltibiaandattheproximalanddistaltibiacompatiblewithbisphosphonatetreatment.
C:Frontalviewofthefootdemonstratessevereosteopeniaandhealingfractureofthedistal4thmetatarsal.
https://t.me/medicina_free
FIGURE1-14.RadiographicpresentationofOsteopetrosis.AP(A)andlateral(B)radiographsoftherightknee
andankle(CandD)inthisadultwithautosomaldominantosteopetrosisdemonstratedense“bonewithinbone”
sclerosisofthefemur,tibia,andfibulawithErlenmeyerflaskdeformityoftheendsofthebones.Themetadiaphyseal
bowingofthedistaltibiaislikelyattributabletofractureremodeling.
https://t.me/medicina_free
PAGETDISEASE
Pagetdisease(osteitisdeformans)isacommonbonedisorder characterizedbydisorganized
boneturnoverandremodelingresultingfromosteoclastoveractivity.
29,30
Thediseaseaffectsup
to5%oftheCaucasianpopulationover50,andcanincreaseinupto10%ofthepopulation
over theageof70.30The etiologyofthe diseaseremainsunknown, withsomepostulatinga
viral origin.30 Although the majorityofpatients are asymptomatic, some presentwithpain,
tenderness, and deformity.29 Paget disease classically is described as having three phases:
lytic, mixed,andlate.The disease often presents withpolyostotic osseous involvementand
with different phases presenting in the same patient.29 The overall, almost pathognomonic
finding is that of disorganized, thickened trabeculae, cortical thickening, and bony
enlargement.29 Paget disease is commonly seen in the pelvis and long bones of the lower
extremity(Fig.1-15).
https://t.me/medicina_free
https://t.me/medicina_free
FIGURE1-15.RadiographicpresentationPaget’s.APradiographofthepelvis(A)andfrogleglateralviewofthe
rightfemur(B)demonstratediffuseinvolvementofthepelvisandrightfemurwithPagetdisease.Thereisbilateral
thickeningoftheiliopectinealandischiopubiclines,diffusetrabecularthickeningintheaffectedareas,mostapparent
intheproximalrightfemur,wherethereisaclassiccoxavaradeformityanddiaphysealbowing.
PSORIATICARTHRITIS
Psoriatic arthritis is an inflammatory arthritis in patients with skin lesions of psoriasis,
classifiedasaseronegativespondyloarthropathyowingtothelackofserumrheumatoidfactor.
Approximately 10% to 15% of patients with skin manifestation of psoriasis will develop
psoriaticarthritis.31The disease mostcommonly involvesthe hands, withthe feetbeing the
secondmostcommon site.Inthefeet,similar tothe hands, thefindingsmaybebilateral or
unilateral,symmetricorasymmetric.32Classically,theinflammationresultsinswelling ofan
entire digit, resulting in the classic findings of “sausage digit.” Although the disease
predominatesintheinterphalangealjoints, itcanalso affectthe metacarpophalangealjoints,
presenting with joint erosion, articular surface irregularity, and, in later stages, bony
ankylosis.32 The radiographic findings include periostitis, articular marginal bone erosion
(“pencil-in-cup” deformities), bony proliferation, and in rare cases dense sclerosis of the
distalphalanxthatcanaffectthegreattoe,aconditiontermed“ivoryphalanx”(Fig.1-16).
31,32
RHEUMATOIDARTHRITIS
Rheumatoid arthritis (RA) is a systemic inflammatory disease of unknown origin that
predominantly affects joint synovial tissues.33 RA is two to three times more common in
women, and onset generally peaks in the fourth and fifth decades. Clinically, patients may
presentearlywithfatigueandgeneralizedaches,witharthritisthendevelopingintheproximal
jointsofhandsandwrists.Involvementinthefeetmayoccur,concurrently.Bilateralsymmetric
marginalerosions,jointspaceloss,juxta-articularosteopenia,andsofttissueswellingaround
thejointsarethemostcommonradiographichallmarksofRA.
33,32
Inthefeet,asinthehands,
thereisapredilectionforproximaljointinvolvement(e.g.,proximalinterphalangeal[PIP]and
MTP joints), commonly at the 4th and 5th MTP joints.
33,32
The lateral margin of the 5th
metatarsalheadisoftenthe1stsiteofaboneerosioninthefootandmayoccurbeforehandor
wristinvolvement.32Inflammatoryretrocalcanealbursitiswithadjacentcalcanealerosionscan
alsooccurintheearlystagesofthedisease(Fig.1-17).
https://t.me/medicina_free
Соседние файлы в папке Библиотека им академика М.И. Перельмана