Osteolysis

Introduction Gorham, also known as Massive osteolysis, Disappearing bone disease, Gorham Stout syndrome, acute spontaneous bone resorption, Phantom bone disease, etc. Chinese medicine called "ghost bone", the West is also called "Phaniom bone". Johnson and Mcclure named the disease a large amount of osteolysis in 1958, and it is now adopted by most people. This condition is extremely rare internationally, and it is believed that prolonged exposure to vinyl chloride can lead to osteolytic osteolysis. It is mainly characterized by multiple osteolysis, especially clavicle, scapula, humerus, chylothorax, nerve damage, hemangioma near the bone damage or lymphangioma, which is often an important clue for diagnosis.

Cause

The etiology and pathogenesis are unclear and are generally thought to be related to family heredity, trauma, infection, aseptic necrosis, central nervous system disorders, psoriatic arthritis, and hemangioma or lymphangioma. At present, most scholars believe that it is related to congenital hereditary or vascular developmental malformation, and some people think it is an aneurysmal lesion, or is associated with lymphangiogenesis. There are only three causes of clinical experience: heredity, tumors, and radiation. It has no ethnic or gender differences and is common among children and adolescents aged 5-25. There are only 5 to 6 cases of "ghost bones" in China, and there are only 200 to 210 cases in the world.

More men than women. More common in the scapula, clavicle, humerus, thoracic vertebrae and ribs. Secondly, it can be found in the pelvis, thoracic vertebrae and lumbar vertebrae. Occurred in the ulna, humerus, carpal bone and metacarpal bone are rare, the humerus, humerus and phalanx are also rare, and sometimes can occur in the upper and lower jaw.

an examination

Related inspection

CT examination of bone and joint and soft tissue in limbs

The main symptoms of the lesion are limb pain, no support, dysfunction of the affected part, pathological fracture is a common symptom and complication.

Lesions occurring in the thoracic spine can cause pathological fractures combined with paraplegia leading to death.

X-ray examination

In the affected part of the bone, the bone is absorbed by the large osteolytic bone, the bone is thinner and the cortex is thinner. After the bone mass is absorbed, the bone defect is present and the stump is sharpened. There are residual loose bones, no new bone, no periosteal reaction, no soft tissue mass.

It is believed that long-term exposure to vinyl chloride can lead to osteolytic osteolysis. It is mainly characterized by multiple osteolysis, especially clavicle, scapula, humerus, chylothorax, nerve damage, hemangioma near the bone damage or lymphangioma, which is often an important clue for diagnosis. In severe cases, the spine cross-cut leads to paraplegia, involving large blood vessels causing major bleeding. Destruction of the skull leads to nerve involvement in the vicinity. Osteolytic disease that occurs in the jaw, often with loose teeth, displacement, or self-shedding, may eventually lead to dissolution of the entire upper and lower jaws and even the skull. Because there is no chin, daily activities such as eating, talking, and even breathing and looking up will be affected, making the patient suffer.

Bone destruction is generally thought to be the proliferation of vascular lymphatic vessels in the bone, causing massive bone lysis. A large amount of fibrosis completely or partially replaces bone tissue and can potentially involve adjacent skin and/or tissue. There are scattered cases reported in this country, Hagberg reported 1 case, no history of traumatic fracture and skin damage. There are few domestic reports. Huang Qiang et al reported in 1996 that only one case had bone damage, but no system damage and skin damage. Wang Tianshu is equivalent to reporting a case of mandibular osteolysis in 2001. After extraction, the mandible is progressively absorbed and pathological fractures occur.

The histopathological manifestations of osteolytic bone were non-specific. Under the light microscope, fibrous tissue hyperplasia was observed, bone tissue was dissolved and absorbed, no osteoclasts were seen, no bone tissue proliferated, and enlarged vascular lumen was seen.

Osteopathy should be differentiated from malignant tumors, early suppurative osteomyelitis, and idiopathic osteolysis associated with kidney disease. Malignant tumors often manifest as unclear masses, often accompanied by local pain, sensation subsided or disappeared, and osteolytic disease does not have this symptom. X-ray films of chronic osteomyelitis often show the formation of dead bone, and the lesions are mostly located in the mandibular and mandibular branches, which are rarely involved at the same time. The X-ray film of osteolytic disease showed no dead bone formation, and the lesion site involved both the mandibular body and the mandibular branch.

Differential diagnosis

It needs to be distinguished from the following symptoms:

A large number of epiphyseal hyperplasia: "bone hyperplasia" commonly known as "bone spur" or "bone sputum" refers to abnormal bone hyperplasia at the edge of bone joints, also known as "osteoarthritis" in the clinic. Also known as "degenerative osteoarthrosis", "hypertrophic osteoarthritis" is an image manifestation of osteoarthritis, a lesion secondary to the destruction of articular cartilage, belonging to the degenerative change of bone, ie "Bone aging" caused.

Diabetes: generally refers to glucose and urine. Normal people have a small amount of glucose in the urine, and the daily urine sugar content is 0.7~0.52 mmo1 (31-93 mg), and the qualitative test is negative. Daily urine sugar exceeds 0.83 IIUnol door p) is positive by qualitative test, called diabetes. The previous qualitative test of diabetes used copper sulfate reagent (Ban's L is based on the reduction of sugar, urine contains glucose, fructose sugar, maltose, pentose, non-sugar substances with reducing effect (some drugs * can be positive In recent years, glucose oxidase paper method has been used to measure urine sugar, which is specific to glucose, but can also be positive when ascorbic acid or salicylate is present.

Bone fracture: A crack is one of the many symptoms in many fractures and is often overlooked. However, if the small problem is not treated in time, it may turn into a big problem. If the fracture is not properly treated, it will shift, causing more trouble.

Crack fracture, also known as fracture of the bone, cannot be given enough attention because there is no obvious displacement. It is generally caused by direct blows, impacts, and the like. Crack fractures can be treated by cast immobilization or small splinting. The wound can heal quickly and usually does not leave sequelae. Treatment is relatively simple and easy.

The main symptoms of the lesion are limb pain, no support, dysfunction of the affected part, pathological fracture is a common symptom and complication.

Lesions occurring in the thoracic spine can cause pathological fractures combined with paraplegia leading to death.

X-ray examination

In the affected part of the bone, the bone is absorbed by the large osteolytic bone, the bone is thinner and the cortex is thinner. After the bone mass is absorbed, the bone defect is present and the stump is sharpened. There are residual loose bones, no new bone, no periosteal reaction, no soft tissue mass.

It is believed that long-term exposure to vinyl chloride can lead to osteolytic osteolysis. It is mainly characterized by multiple osteolysis, especially clavicle, scapula, humerus, chylothorax, nerve damage, hemangioma near the bone damage or lymphangioma, which is often an important clue for diagnosis. In severe cases, the spine cross-cut leads to paraplegia, involving large blood vessels causing major bleeding. Destruction of the skull leads to nerve involvement in the vicinity. Osteolytic disease that occurs in the jaw, often with loose teeth, displacement, or self-shedding, may eventually lead to dissolution of the entire upper and lower jaws and even the skull. Because there is no chin, daily activities such as eating, talking, and even breathing and looking up will be affected, making the patient suffer.

Bone destruction is generally thought to be the proliferation of vascular lymphatic vessels in the bone, causing massive bone lysis. A large amount of fibrosis completely or partially replaces bone tissue and can potentially involve adjacent skin and/or tissue. There are scattered cases reported in this country, Hagberg reported 1 case, no history of traumatic fracture and skin damage. There are few domestic reports. Huang Qiang et al reported in 1996 that only one case had bone damage, but no system damage and skin damage. Wang Tianshu is equivalent to reporting a case of mandibular osteolysis in 2001. After extraction, the mandible is progressively absorbed and pathological fractures occur.

The histopathological manifestations of osteolytic bone were non-specific. Under the light microscope, fibrous tissue hyperplasia was observed, bone tissue was dissolved and absorbed, no osteoclasts were seen, no bone tissue proliferated, and enlarged vascular lumen was seen.

Osteopathy should be differentiated from malignant tumors, early suppurative osteomyelitis, and idiopathic osteolysis associated with kidney disease. Malignant tumors often manifest as unclear masses, often accompanied by local pain, sensation subsided or disappeared, and osteolytic disease does not have this symptom. X-ray films of chronic osteomyelitis often show the formation of dead bone, and the lesions are mostly located in the mandibular and mandibular branches, which are rarely involved at the same time. The X-ray film of osteolytic disease showed no dead bone formation, and the lesion site involved both the mandibular body and the mandibular branch.

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