Rogalsky R J, Black G B, Reed M H
J Bone Joint Surg Am. 1986 Apr;68(4):494-501.
Acute leukemia of childhood may present with various clinical manifestations that mimic orthopaedic conditions. The osseous radiographic abnormalities of this disease, although well described in the literature, are not pathognomonic, and certain changes may not be as frequent as was previously thought. In a retrospective study, we reviewed the cases of 107 patients, less than eighteen years old, who had been seen at the Winnipeg Children's Hospital. The mean follow-up was 4.6 years for the fifty-eight patients who were still alive and 2.0 years for the forty-nine non-survivors. In twenty-two (20.6 per cent) of the patients, the presenting complaints were pain in the extremities, back pain, osteomyelitis, septic arthritis, or fracture. The radiographic abnormalities, which were present in forty-seven (43.9 per cent) of the children at the time of diagnosis, were osteopenia, lytic lesions, metaphyseal bands, periosteal new bone, and sclerotic lesions. Since the initial symptoms of leukemia commonly involve the musculoskeletal system, a high index of suspicion must be maintained by orthopaedic surgeons.
儿童急性白血病可能表现出各种类似骨科病症的临床表现。尽管该病的骨影像学异常在文献中有详细描述，但并非具有诊断特异性，而且某些变化可能不像以前认为的那么常见。在一项回顾性研究中，我们回顾了在温尼伯儿童医院就诊的107例18岁以下患者的病例。58例存活患者的平均随访时间为4.6年，49例非存活患者的平均随访时间为2.0年。22例（20.6%）患者的首发症状为肢体疼痛、背痛、骨髓炎、化脓性关节炎或骨折。47例（43.9%）儿童在诊断时存在影像学异常，包括骨质减少、溶骨性病变、干骺端带、骨膜新生骨和硬化性病变。由于白血病的初始症状通常累及肌肉骨骼系统，骨科医生必须保持高度的怀疑指数。
