Moreno A, Clemente J, Crespo C, Martínez A, Navarro M, Fernández L, Minguell J, Vázquez G, Andreu F J
Department of Radiation Oncology, University Hospital of San Juan, Alicante, Spain.
Int J Radiat Oncol Biol Phys. 1999 Apr 1;44(1):61-6. doi: 10.1016/s0360-3016(98)00534-3.
Insufficiency fractures (IF) occur as a result of normal physiological stress on bones with deficient elastic resistance. Pelvic insufficiency fractures are a complication of osteoporosis due to postmenopausal status, high dose of corticosteroids, or local irradiation. They are important because differential diagnosis includes pelvic bone metastases. Diagnosis is based on both clinical manifestations and radiographic and scintigraphic findings.
We examined eight patients with pelvic cancer who had previously undergone external beam radiation therapy as part of their treatment. In the follow-up, they developed insufficiency fractures, and no factor other than pelvic irradiation was present. Diagnosis was confirmed by radionuclide bone scan followed by conventional radiography and computed tomography (CT) scan.
The average onset of symptoms was 13.7 months after radiation therapy was completed. The initial symptom in all cases was pain. In all of the patients, the bone scan showed abnormalities. One to four increased uptake foci were observed, in the sacroiliac joint in all cases, and in the pubis in three cases. The initial diagnosis was bone metastases in five patients. CT scan showed fractures in all of the patients, in sacrum and pubis, both endostic and cortical. Treatment, consisting of nonsteroidal anti-inflammatory drugs and rest, led to symptomatic relief in all cases.
Knowledge of pelvic insufficiency fractures is essential in order to rule out metastasic disease, and thus avoid inaccurate treatment. Although radionuclide bone scan is useful in early detection of pelvic IF, definitive diagnosis is provided by CT scan.
应力性骨折（IF）是由于骨骼弹性阻力不足时的正常生理应力所致。骨盆应力性骨折是绝经后状态、高剂量皮质类固醇或局部放疗导致的骨质疏松症的并发症。它们很重要，因为鉴别诊断包括骨盆骨转移。诊断基于临床表现以及影像学和闪烁扫描结果。
我们检查了8例骨盆癌患者，这些患者之前接受过外照射放疗作为其治疗的一部分。在随访中，他们发生了应力性骨折，且除骨盆放疗外不存在其他因素。通过放射性核素骨扫描，随后进行传统X线摄影和计算机断层扫描（CT）来确诊。
症状平均在放疗结束后13.7个月出现。所有病例的初始症状均为疼痛。所有患者的骨扫描均显示异常。观察到1至4个摄取增加灶，所有病例均在骶髂关节，3例在耻骨。最初有5例患者被诊断为骨转移。CT扫描显示所有患者均有骨折，位于骶骨和耻骨，包括骨内膜和皮质。治疗包括使用非甾体抗炎药和休息，所有病例症状均缓解。
了解骨盆应力性骨折对于排除转移性疾病并避免不准确的治疗至关重要。虽然放射性核素骨扫描有助于早期发现骨盆IF，但CT扫描可提供明确诊断。
