Fritz P, Baldauf G, Wilke H J, Reitter I
Radiological Clinic, University of Heidelberg, Germany.
Ann Rheum Dis. 1992 May;51(5):658-64. doi: 10.1136/ard.51.5.658.
Twelve cases of sternocostoclavicular hyperostosis were followed up over four to 16 years. The patients underwent repeated radiological examinations of the sternocostoclavicular joints and the sternum, and the extrasternal osseous manifestations of the disease were studied to show changes in the radiological features during long term follow up. Five of 12 (41%) patients had extrasternal manifestations. With the exception of one patient extrasternal manifestations were first detected by scintigraphs because they were asymptomatic. With respect to the sternal manifestations the initial radiological diagnosis was made during an acute phase while painful swelling over the sternum and decreased mobility of the shoulders occurred. The radiological examinations showed the signs of a proliferative destructive arthritis in most patients. In contrast with the frequent occurrences of clinical symptoms, the radiological signs of progression take several years to become detectable. There are no specific bacteriological, serological or histological findings. Usually a permanent increase in the erythrocyte sedimentation rates is found. Sternocostoclavicular hyperostosis is a slowly progressing disease, characterised by a chronic aseptic destructive sternoclavicular arthritis with a reactive low turnover sclerosis that begins in a similar way to an enthesopathy and ends after several decades with total ankylosis. The radiological identification of retrosternal proliferation of soft tissue by computed tomography was found to be a valuable criterion for the differential diagnosis from other benign hyperostotic processes of the sternoclavicular region.
对12例胸锁关节骨肥厚患者进行了4至16年的随访。患者接受了胸锁关节和胸骨的多次放射学检查，并对该疾病的胸骨外骨表现进行了研究，以显示长期随访期间放射学特征的变化。12例患者中有5例（41%）有胸骨外表现。除1例患者外，胸骨外表现最初是通过闪烁扫描发现的，因为这些表现无症状。关于胸骨表现，最初的放射学诊断是在急性期做出的，当时胸骨出现疼痛性肿胀且肩部活动度降低。放射学检查显示大多数患者有增生性破坏性关节炎的征象。与临床症状频繁出现形成对比的是，进展的放射学征象需要数年才能被检测到。没有特异性的细菌学、血清学或组织学发现。通常会发现红细胞沉降率持续升高。胸锁关节骨肥厚是一种进展缓慢的疾病，其特征为慢性无菌性破坏性胸锁关节炎，伴有反应性低转换硬化，该病以类似附着点病的方式开始，数十年后以完全强直告终。通过计算机断层扫描对胸骨后软组织增生进行放射学识别，被发现是与胸锁关节区域其他良性骨肥厚性病变进行鉴别诊断的一个有价值的标准。
