Sundaram M, Dessner D, Ballal S
Department of Radiology, St. Louis University Medical Center, Missouri.
Skeletal Radiol. 1991;20(2):91-4. doi: 10.1007/BF00193817.
Aluminum-induced bone disease in uremic patients receiving dialysis was first described a little more than 10 years ago. The epidemic form of the disease was seen in centers where there was a high aluminum content in the water dialysate. Although this problem has been corrected, sporadic forms of the disease continue to be noted in dialyzed and nondialyzed patients. Multiple fractures are a radiological feature of aluminum-related bone disease. Fractures of the ribs and hips and vertebral crush fractures are the usual manifestations. We present four patients whose nontraumatic fractures involved large bones, without evidence of multiple fractures. In two of the patients symptoms were vague and subacute; a third patient with a subcapital fracture was ambulatory. Only in one patient (fractured dens) were symptoms acute enough to warrant immediate radiography. One of the patients had no symptoms pertaining to a fracture of C5 with retrolisthesis. Rib fractures are common in this condition but were seen in only one patient, in whom they were detected 8 years previously. Healing was not seen in any of the fractures. In patients receiving dialysis the presence of spontaneous fractures of large bones or cervical vertebrae, which may be clinically silent or vaguely symptomatic, should raise the possibility of aluminum-induced osteomalacia even if these fractures are solitary.
接受透析的尿毒症患者铝诱导的骨病在10多年前首次被描述。在透析液水中铝含量高的中心可见到该病的流行形式。尽管这个问题已得到纠正，但在接受透析和未接受透析的患者中仍不断发现散发性病例。多发性骨折是铝相关性骨病的一个放射学特征。肋骨和髋部骨折以及椎体压缩性骨折是常见表现。我们报告4例非创伤性骨折累及大骨的患者，无多发性骨折证据。其中2例患者症状模糊且呈亚急性；第3例患者为股骨头下骨折，可行走。仅1例患者（齿状突骨折）症状足够急性，需立即进行X线检查。1例患者C5椎体骨折伴椎体后移但无相关症状。肋骨骨折在这种情况下很常见，但仅在1例患者中见到，该例患者的肋骨骨折于8年前被发现。所有骨折均未见愈合。在接受透析的患者中，即使是孤立的大骨或颈椎自发性骨折，临床症状可能不明显或仅有模糊症状，也应考虑铝诱导骨软化症的可能性。
