早期先天性梅毒的骨骼X线表现  

X-ray findings of bone and joints in early congenital syphilis

作　　者：丁一[1] 曹智[1] 黄汝刚[1] 

机构地区：[1]天津市第二人民医院放射科,天津300041

出　　处：《放射学实践》2013年第9期976-979,共4页Radiologic Practice

摘　　要：目的：探讨先天性梅毒的骨骼x线表现。方法：搜集2011年10月-2012年10月23例先天性梅毒患者，其中男14例，女9例，年龄半个月一2岁。所有23例患者均给予青霉素G（15～20万U／kg·d），每天2～3次，持续14天。回顾性分析治疗前后临床和影像学表现。结果：治疗前23例患儿中有19例骨骼x线表现异常，按发生异常的部位分为干骺端炎、骨膜炎、骨髓炎。干骺端炎5例，表现为长管状骨干骺端的先期钙化带不规则增厚伴或不伴其下方透亮带、干骺端尖角样改变及干骺端骨质坏死；骨膜炎10例，其中包括干骺端炎合并骨膜炎5例，表现为与长骨伴行的葱皮样骨膜增厚；未发现骨髓炎患者；其他如髂骨等不规则骨发现皮质下透亮带形成2例，长骨两端骨质密度减低2例。以上表现均为多发，呈对称性分布，干骺端炎出现最早，骨膜炎最常见，且干骺端炎多伴发骨膜炎。经过系统治疗后复查X片显示疗效显著。结论：凡经确诊的先天性梅毒患儿，无论有无临床症状，均应常规行四肢长骨X线检查，对表现异常者给予早期治疗，能够达到满意疗效。Objective： To explore X-ray manifestations of the bone and joints in the congenital syphilis. Methods： Twenty-three patients with congenital syphilis were collected from October, 2011 to October, 2012, including fourteen males and nine females,with an age range of half month to 24 months. All 23 patients were given Penicillin G of 15~20WU/（kg · d） for 2~3 times per day for continuous fourteen days. The clinical and radiographic features were respectively analyzed before and after treatment. Results ： Before treatment, bone abnormalities, including metaphysitis, periostitis and osteomyelitis were identified in 19 of 23 cases. Five patients had metaphysitis, appearing as irregularly thickened provisional calcification zone,with or without a osteoporotic zone beneath it, saw-toothed metaphysis and metaphyseal bone necrosis. Ten patients had periostitis,of which five patients also had metaphysitis with onion skin like periosteal thickening. Two patients had sub cortical radiolucent zone in the irregular bone such as ilium. Two patients had a decreased bone density at both ends of the long bone. The abnormalities were multiple, and bilaterally distributed, with the metaphysis earliest involved. The periostitis was the most commonly seen and was often associated with metaphysitis. After the treatment, the abnormalities were signif icantly improved on the re-examinations of X-ray film. Conclusion： Radiography of the long bone in extremities should be routinely performed in the children with congenital syphilis, regardless of clinical symptoms present or not. Early treatment for the patients with radiological abnormalities can achieve a satisfied result.

关 键 词：梅毒 先天性 骨骼 体层摄影术 X线计算机 

分 类 号：R759.1[医药卫生—皮肤病学与性病学] R814.3[医药卫生—临床医学]