Vài bệnh lý xương khớp Biến dưỡng (Metabolic osteoarthropathy) BS Nguyễn Văn Công TTYK MEDIC Đại cương Xương gồm: Chất gian bào: -Chất dạng xương (osteoid) gồm collagen, mucopolysaccharide -Chất khoáng: calcium phosphate, Hydroxy apatite - Tế bào: nguyên cốt bào (osteoblast), hủy cốt bào (osteoclast) Xương lúc đổi nhờ cân hủy xương tạo xương, có cân có thiểu xương (osteopenia) đặc xương (osteosclerosis) Hormon ảnh hưởng chuyển hóa xương: Para-thyroid, hormon giới tính, thượng thận… Các vitamin cần thiết vit D, vit C… Dinh dưỡng Một số thuốc steroid, heparin, chống kinh giật Bất động tăng loãng xương Xương vỏ Thân xương Đồng nhất, đặc, xuyên qua ống Havers Mosaïque Ostéone / canal Havers C os Ligne cimentante Xương sốp Nhiều bè xương Mạng dạng tổ ong Vôi hóa không đồng X 32 Os trabéculaire Cartilage calcifié X 110 Sơ đồ cấu trúc xương bình thường & số bệnh lý: Hình a: 1-Xương đặc 2- Màng xương 3- xương sốp Khoảng tủy Hình b: phần vỏ tủy xương bình thường Hình c: bệnh nhuyễn xương: mạng protein bình thường vôi hóa Hình d: Loãng xương mạng protein giãm vôi hóa bình thường Hình e: tiêu xương màng xương, brown tumor Hình f: bệnh Paget không phân biệt vỏ-tủy Hình g: hyperostosis Hình h: đặc xương nhiều Osteopenia increase lucency of bone due to: – – – – Osteoporosis : decrease of normal bone Osteomalacia: decrease of bone mineralisation Hyperparathyroidism: increase bone resorption Multiple myeloma: bone replaced by tumor Causes of Osteopenia Localized osteopenia • Disuse osteoporosis: pain, immobilization • Arthritis • Sudeck’s atrophy, reflex sympathetic dystrophy • Paget’s disease (lytic phase) • Transient osteoporosis Transient osteoporosis of the hip Regional migratory osteoporosis Sudeck ‘s atrophy Diffuse osteopenia Osteoporosis Endocrine diseases Nutritional deficiencies Hereditary metabolic and collagen disorders Medications Osteomalacia Nutritional deficiences Abnormal vitamin D metabolism (inherited, acquired) GI absorption disorders Renal disease Medications HPT Malignancy (e.g., myeloma) Marrow hyperplasia (e.g., hemoglobinopathy) Lysosomal storage diseases (e.g., Gaucher’s disease) Osteonecrosis of L femoral head in early phase: Plain X ray almost normal Marked bone lesion on MRI Late stage of osteonecrosis with secondary arthrosis Sclerotic bone lesion Slow growing lesion Forming bone area around offender Can be local, focal or diffuse Generic Differential Diagnosis of Sclerotic Bone Lesions • Vascular • hemangiomas • infarct • Infection • chronic osteomyelitis • Neoplasm • primary • osteoma • osteosarcoma • metastatic • prostate • breast • other Generic Differential Diagnosis of Sclerotic Bone Lesions • Drugs • Vitamin D • fluoride • Inflammatory/Idiopathic • Congenital • bone islands • osteopoikilosis • osteopetrosis • pyknodysostosis • Melorheostosis (nến xương) • Autoimmune • Trauma • fracture (stress) • Endocrine/Metabolic • hyperparathyroidism • Paget's disease Differential Diagnosis of Focal or Multifocal Sclerotic Bone Lesions • Vascular • hemangiomas • infarct • Infection • chronic osteomyelitis • Neoplasm • primary • osteoma • osteosarcoma • metastatic • prostate • breast • other Differential Diagnosis of Focal or Multifocal Sclerotic Bone Lesions • Congenital • bone islands • osteopoikilosis • Trauma • fracture (stress) • Endocrine/Metabolic • Paget's disease Osteopoikilosis Differential Diagnosis of Diffuse Sclerotic Bone Lesions • Vascular • infarct (e.g sickle cell) • Neoplasm • metastatic • prostate • breast • other • Drugs • Vitamin D • fluoride • Congenital • osteopetrosis • pyknodysostosis • Endocrine/Metabolic • hyperparathyroidism Wise saying about sclerotic There are a number of other helpful findings you can look for that can help you to cone in on or away from specific entities in one of these differential lists -Most cases of chronic osteomyelitis look pretty nonspecific However, if one sees sinus tracts associated with a sclerotic area, one should strongly consider osteomyelitis Diffuse skeletal infarcts can be a common cause of diffuse skeletal sclerosis In fact, in areas where sickle cell disease is common, this may be the leading cause of diffuse sclerotic bones When you are considering osteonecrosis in your differential diagnosis, look at the joints carefully If you can find evidence of subchondral collapse or the typical lucent/sclerotic appearance of the necrotic bone in the weightbearing bone, then osteonecrosis becomes a much more likely diagnosis Wise saying about sclerotic -Patients with sclerotic lesions due to metastasis often have a history of prior malignant disease Ask the patient or the clinician about this -Likewise patients with sclerotic lesions due to various drugs or minerals will tell you what they are taking if you ask them -When considering congenital causes of sclerotic lesions, benign causes such as bone islands or osteopoikilosis usually have a fairly typical appearance and are hard to mistake Osteopetrosis and pyknodysostosis are likewise hard to mistake for other entities since the bones are denser than in any other disorder, and the long bones tend to have very tiny medullary canals Wise saying about sclerotic -When considering trauma as a cause for sclerotic lesions, remember to check and see if the areas involved are areas in the typical distribution for stress fractures -When considering hyperparathyroidism, look for evidence of subperiosteal bone resorption -When considering Paget's disease, it is extremely helpful to note whether there is associated bony enlargement This is extremely common in Paget's disease but extremely uncommon with a blastic metastasis Another finding classic for Paget's disease is that it almost always starts at one end of a bone and then spreads toward the other end of the bone ... cimentante X? ?ơng sốp Nhiều bè x? ?ơng Mạng dạng tổ ong Vôi hóa không đồng X 32 Os trabéculaire Cartilage calcifié X 110 Sơ đồ cấu trúc x? ?ơng bình thường & số bệnh lý: Hình a: 1 -X? ?ơng đặc 2- Màng x? ?ơng... Quang Radiologie       Loãng x? ?ơng 5/5 Hủy x? ?ơng đầu chi 3/5 Gãy x? ?ơng bệnh lý x? ?ơng chi & cột sống 3/5 U nâu 1/5 Biến dạng x? ?ơng : 4/5 Sạn niệu cản quang : 1/5  Osteùopeùnie: 5/5cas... (osteoblast), hủy cốt bào (osteoclast) X? ?ơng lúc đổi nhờ cân hủy x? ?ơng tạo x? ?ơng, có cân có thiểu x? ?ơng (osteopenia) đặc x? ?ơng (osteosclerosis) Hormon ảnh hưởng chuyển hóa x? ?ơng: Para-thyroid, hormon giới