Worgul Christopher A, Freccero David M
Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA, USA.
Arthroplast Today. 2022 May 30;16:73-77. doi: 10.1016/j.artd.2022.03.014. eCollection 2022 Aug.
The deposition of amyloid within human tissue can be detrimental to the proper functioning of multiple organ systems. While the infiltration of the amyloid protein within the musculoskeletal soft tissues can lead to compressive neuropathies, tendon irritation or rupture, and joint stiffness, pathologic fracture as a result of amyloid deposition in bone is a rare manifestation of amyloidosis. We present a case of pathologic fracture of the femoral neck from amyloid deposition in a 59-year-old male on chronic hemodialysis who was found to have lytic lesions in his proximal femur. At the time of hemiarthroplasty, histopathologic analysis of a femoral head sample revealed apple-green birefringence of the deposits under polarized light, consistent with amyloid deposition. Clinicians should have a high index of suspicion for the atypical presentation of amyloidosis in a patient on chronic hemodialysis with lytic bone lesions.
淀粉样蛋白在人体组织中的沉积可能会损害多个器官系统的正常功能。虽然淀粉样蛋白在肌肉骨骼软组织中的浸润可导致压迫性神经病变、肌腱刺激或断裂以及关节僵硬，但骨内淀粉样蛋白沉积导致的病理性骨折是淀粉样变性的一种罕见表现。我们报告一例59岁男性慢性血液透析患者因淀粉样蛋白沉积导致股骨颈病理性骨折的病例，该患者近端股骨发现有溶骨性病变。在半髋关节置换术时，对股骨头样本进行组织病理学分析，发现在偏振光下沉积物呈苹果绿双折射，符合淀粉样蛋白沉积。临床医生对于慢性血液透析且有溶骨性骨病变的患者出现淀粉样变性的非典型表现应保持高度怀疑。
