Rivera Frances, Mirazón Lahr Marta
Department of Archaeology & Anthropology, Leverhulme Centre for Human Evolutionary Studies, University of Cambridge, United Kingdom.
Am J Phys Anthropol. 2017 Sep;164(1):76-96. doi: 10.1002/ajpa.23258. Epub 2017 Jun 8.
Porotic hyperostosis (PH), characterized by porotic lesions on the cranial vault, and cribra orbitalia (CO), a localized appearance of porotic lesions on the roof of the orbits, are relatively common osteological conditions. Their etiology has been the focus of several studies, and an association with anemia has long been suggested. Anemia often causes bone marrow hypertrophy or hyperplasia, leading to the expansion in trabecular or cranial diploic bone as a result of increased hematopoiesis. Hypertrophy and/or hyperplasia is often coupled with a disruption of the remodeling process of outer cortical bone, cranially and/or postcranially, leading to the externally visible porotic lesions reported in osteological remains. In this article, we investigate whether individuals with CO have increased thickness of the diploë, the common morphological direct effect of increased hematopoiesis, and thus test the relationship between the two conditions, as well as explore the type of anemia that underlie it.
An analysis of medical CT scans of a worldwide sample of 98 complete, young to middle-aged adult dry skulls from the Duckworth Collection was conducted on male and female cribrotic individuals (n = 23) and noncribrotic individuals (n = 75), all of whom lacked any evidence of porotic lesions on the vault. Measurements of total and partial cranial thickness were obtained by virtual landmark placement, using the Amira 5.4 software; all analyses were conducted in IBM SPSS 21.
Cribriotic individuals have significantly thinner diploic bone and thicker outer and inner tables than noncribriotic individuals, contrary to the expected diploic expansion that would result from anemic conditions associated to bone marrow hypertrophy or hyperplasia. Additionally, individuals without CO and those with the condition have distinctive cranial thickness at particular locations across the skull and the severity to which CO is expressed also differentiates between those with mild and those with a moderate to severe form of the condition.
Our results suggest a complex pattern of causality in relation to the pathologies that may lead to the formation of porotic lesions on the vault and the roof of the orbits. A form of anemia may be behind the osteological changes observed in PH and CO, but it is unlikely to be the same type of anemic condition that underlies both types of osteological lesions. We suggest that CO may be associated to anemias that lead to diploic bone hypocellularity and hypoplasia, such as those caused by anemia of chronic disease and, to a lesser extent, of renal failure, aplastic anemia, protein deficiency, and anemia of endocrine disorders, and not those that lead to bone marrow hypercellularity and hyperplasia and potential PH. This leads us to the conclusion that the terms PH and CO should be used to reflect different underlying conditions.
颅骨疏松性骨质增生（PH），其特征为颅顶出现多孔性病变，以及眶筛骨病变（CO），即眼眶顶部多孔性病变的局部表现，是相对常见的骨骼状况。它们的病因一直是多项研究的重点，长期以来人们一直认为它们与贫血有关。贫血通常会导致骨髓肥大或增生，由于造血增加，导致小梁骨或颅骨板障骨扩张。肥大和/或增生通常伴随着颅骨和/或颅后骨外皮质骨重塑过程的破坏，导致骨骼遗骸中出现外部可见的多孔性病变。在本文中，我们研究患有CO的个体是否具有板障增厚的情况，这是造血增加常见的形态学直接影响，从而检验这两种情况之间的关系，并探究其背后的贫血类型。
对来自达克沃思收藏的98个完整的年轻至中年成人干燥头骨的全球样本进行医学CT扫描分析，这些样本包括患有筛骨病变的个体（n = 23）和未患筛骨病变的个体（n = 75），所有个体在颅顶均无任何多孔性病变的迹象。使用Amira 5.4软件通过虚拟地标放置获得颅骨总厚度和部分厚度的测量值；所有分析均在IBM SPSS 21中进行。
与预期的因与骨髓肥大或增生相关的贫血状况导致的板障扩张相反，患有筛骨病变的个体的板障骨明显更薄，外板和内板更厚。此外，没有CO的个体和患有该病症的个体在颅骨特定位置的颅骨厚度有明显差异，并且CO表现的严重程度在轻度患者和中度至重度患者之间也有所不同。
我们的结果表明，与可能导致颅顶和眼眶顶部多孔性病变形成的病理状况相关的因果关系模式较为复杂。某种形式的贫血可能是PH和CO中观察到的骨骼变化的背后原因，但不太可能是这两种骨骼病变背后的同一种贫血状况。我们认为，CO可能与导致板障骨细胞减少和发育不全的贫血有关，例如由慢性病贫血以及在较小程度上由肾衰竭、再生障碍性贫血、蛋白质缺乏和内分泌紊乱性贫血引起的贫血，而不是导致骨髓细胞增多和增生以及潜在PH的贫血。这使我们得出结论，PH和CO这两个术语应被用于反映不同的潜在状况。
