Soubrier M, Dubost J J, Oualid T, Sauvezie B, Ristori J M, Bussière J L
Service de Rhumatologie, Hôpital G.-Montpied, CHU, Clermont-Ferrand.
Ann Med Interne (Paris). 1994;145(7):474-7.
Longitudinal stress fractures of the tibia are rare: only 16 cases have been published. We report three cases, in two men aged 54 and 70 years and in one women aged 73. The patients had pain when bearing weight on the affected limb. The pain increased over a few weeks. A diagnosis of arthritis of the ankle joint was entertained in 2 cases. Among the three patients, one was suffering from rheumatoid arthritis and had had Ender nails due to fracture of the femoral neck of the same limb. The longest delay for diagnosis was six months. Plain radiographs were normal in two cases. A technetium 99m MDP bone scan showed increased uptake of the whole shaft of the tibia in one patient, on the lower end of the tibia in two others. Computed tomography was performed in two cases and showed the stress fracture. Diagnosis was often delayed because clear changes at plain X-ray examination, periostal reaction often being delayed. Technetium 99m bone scan early showed increased uptake. CT scan showed callus formation and sometimes the fracture itself. MRI has been studied little.
仅16例病例被报道过。我们报告3例，其中2例为男性，年龄分别为54岁和70岁，1例为73岁女性。患者患侧肢体负重时疼痛，疼痛在数周内加重。2例曾考虑诊断为踝关节关节炎。3例患者中，1例患有类风湿关节炎，且因同一肢体股骨颈骨折曾植入恩得钉。诊断最长延迟6个月。2例患者的X线平片正常。1例患者的锝99m亚甲基二膦酸盐（MDP）骨扫描显示胫骨整个骨干放射性摄取增加，另2例显示胫骨下端放射性摄取增加。2例患者进行了计算机断层扫描（CT），显示为应力性骨折。诊断常常延迟，因为X线平片检查的明显改变、骨膜反应常常延迟出现。锝99m骨扫描早期显示放射性摄取增加。CT扫描显示骨痂形成，有时能显示骨折本身。关于磁共振成像（MRI）的研究很少。
