Jackson A, Reilly M, Watson S
Department of Diagnostic Radiology, Medical School, University of Manchester, UK.
Skeletal Radiol. 1992;21(3):155-9. doi: 10.1007/BF00242128.
Plain radiographs of the limbs were reviewed after replantation procedures following traumatic amputation in 5 patients at the wrist (2), mid-forearm (2) and knee (1). Following upper limb replantation, rapid development of osteopaenia was initially noted in the juxta-articular regions and metaphyses of the tubular bones of the hand. These changes were followed by diaphyseal cortical bone loss with evidence of subperiosteal, intracortical and endosteal bone resorption. Juxta-articular erosions developed at the margins of the small joints in the hand in all cases. Gradual resolution of bone changes was noted in 3 of the 4 cases where follow-up exceeded 5 years. Following lower limb replantation, there was no evidence of bone loss; however, severe neuropathic joint disease developed within 18 months and progressed over the following 9 years. We suggest that the radiographic changes observed after upper limb replantation reflect regional hyperaemia secondary to neurovascular damage, whilst the changes in the lower limb reflect a similar process in a limb subjected to weight bearing.
对5例因创伤性截肢而接受再植手术的患者（2例腕部、2例前臂中部、1例膝部）术后的四肢X线平片进行了回顾性分析。上肢再植后，最初在手管状骨的关节周围区域和干骺端发现骨质疏松迅速发展。随后出现骨干皮质骨丢失，并伴有骨膜下、皮质内和骨内膜骨吸收的迹象。所有病例中手部小关节边缘均出现关节周围侵蚀。在随访超过5年的4例病例中，有3例骨改变逐渐消退。下肢再植后，没有骨质流失的证据；然而，在18个月内出现了严重的神经性关节病，并在接下来的9年中进展。我们认为，上肢再植后观察到的影像学改变反映了神经血管损伤继发的局部充血，而下肢的改变反映了在承受重量的肢体中类似的过程。
