Mayer Matthieu J, Gliedt Jordan A, Shaker Joseph L, Symanski John S
From the Departments of Radiology (M.J.M., J.S.S.), Neurosurgery (J.A.G.), and Endocrinology (J.L.S.), Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226.
Radiology. 2021 Oct;301(1):239-241. doi: 10.1148/radiol.2021203740.
History A 37-year-old man from the United States presented with a 1-year history of neck pain and stiffness that had been unsuccessfully treated with manipulative therapy by a chiropractor at another institution. Past medical history was remarkable only for marijuana and air duster abuse. He denied use of any prescription medications. Physical examination was notable for markedly reduced range of motion of the cervical spine. Laboratory work-up revealed an elevated alkaline phosphatase level (302 U/L [5.0 μkat/L]; normal range, 40-100 U/L [0.7-1.67 μkat/L]), but all other laboratory findings, including complete blood count, renal function, liver function, vitamin A level, serum protein electrophoresis, and hepatitis C antibodies were within normal limits. Cervical spine radiography was performed (Fig 1), followed by MRI (Fig 2). Subsequently, a full skeletal survey was ordered. Included are representative radiographs of the pelvis (Fig 3), left forearm (Fig 4), and distal right leg with ankle (Fig 5).
病史 一名来自美国的37岁男性，有1年颈部疼痛和僵硬病史，曾在另一机构接受脊椎按摩师的手法治疗，但未成功。既往病史仅以滥用大麻和气雾剂显著。他否认使用任何处方药。体格检查显示颈椎活动范围明显减小。实验室检查发现碱性磷酸酶水平升高（302 U/L [5.0 μkat/L]；正常范围，40 - 100 U/L [0.7 - 1.67 μkat/L]），但所有其他实验室检查结果，包括全血细胞计数、肾功能、肝功能、维生素A水平、血清蛋白电泳和丙型肝炎抗体均在正常范围内。进行了颈椎X线检查（图1），随后进行了MRI检查（图2）。随后，下令进行全面的骨骼检查。包括骨盆（图3）、左前臂（图4）和右下肢远端及踝关节（图5）的代表性X线片。
