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Re: Компрессионный перелом
Alexander Chelnokov 12 Июнь 2002, 13:03
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AM> Может ли деструкция в левой задне-лобно-височной области быть связана с
AM> системним остеопорозм позвонков и пат. переломом?
Всякого рода сенильные переломы и гормональные спондилопатии вполне бывают и без опухолей содержимого черепной коробки.
AM> Моигут ли эпилптические приступы явиться причиной компрессионного перелома
AM> позвонков?
Конечно.
AM> Какие дополнительные исследования нужны для дифдиагностики болезни Куммелля?
Это AFAIR коллапс тела позвонка, который может быть результатом многих состояний. Вот кое-что попалось про диагностику:
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Differentiation of Malignant Vertebral Collapse from Osteoporotic and
Other Benign Causes Using Magnetic Resonance Imaging
D Y L Tan,*MBBS, FRCR (UK) , I Y Y Tsou,*MBBS, FRCR (UK) , T S G
Chee,**FAMS, MBBS, FRCR (UK)
Abstract
Introduction: Elderly patients presenting with backache and vertebral
collapse are a diagnostic challenge. Plain X-rays, computed
tomography and radionuclide bone scans have not always reliably
distinguished between benign and malignant causes. Magnetic resonance
imaging (MRI) may be able to do so. Materials and Methods: Patients
who underwent MRI evaluation for vertebral collapse were
retrospectively studied. Over a 21-month period from January 1995 to
September 1996, 47 patients with 58 vertebral collapses were studied.
Benign and malignant aetiologies were established by serial imaging,
clinical outcome and histology. Imaging was performed with T1 and
T2-weighted sequences, with contrast enhancement in some patients.
Collapsed vertebrae were examined for appearance of marrow on T1
and T2-weighted sequences and after contrast administration, signal
intensity of adjacent discs, degree of marrow involvement, involvement
of posterior elements, presence or absence of paraspinal mass and
end-plate integrity. Agreement between the final and radiological
diagnosis was evaluated. Results: There were 36 benign vertebral
collapses (20 osteoporotic, 7 post-traumatic, 9 infective) and 22
malignant ones (20 metastatic carcinoma, 2 multiple myeloma). Features
which pointed t o malignant cause were hypointense marrow on
T1-weighted images, marrow enhancement after intravenous contrast,
greater than 50% marrow involvement and involvement of posterior
elements. Of the vertebral collapses due to infection, 78% showed
end-plate disruption. Conclusions: This study shows that MRI can be
used to accurately differentiate between benign and malignant causes
of vertebral collapse. Further differentiation between an
osteoporotic, traumatic or infective cause can be done with the help
of clinical history and evaluation of end-plate integrity.
Ann Acad Med Singapore 2002; 31:8-14
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AM> Тактика лечения (корсет?), показания и противопоказания к хирургическому
AM> вмешательству на позвонках в данной ситуации
А оперировать-то что?
AM> Прогноз?
Постараюсь про этого пациента у наших вертебрологов спросить, но раньше пятницы, скорее всего, не получится.
--
Best regards,
Alexander N. Chelnokov
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