Murphey M D, Sartoris D J, Quale J L, Pathria M N, Martin N L
Department of Diagnostic Radiology, University of Kansas Medical Center, Kansas City 66160-7234.
Radiographics. 1993 Mar;13(2):357-79. doi: 10.1148/radiographics.13.2.8460225.
Abnormalities involving the musculoskeletal system are numerous and frequent in patients with chronic renal insufficiency (CRI). The most common radiologic manifestations of CRI are those referred to collectively as renal osteodystrophy: the findings seen in secondary hyperparathyroidism (bone resorption, periosteal reaction, and brown tumors), osteoporosis, osteosclerosis, osteomalacia, and soft-tissue and vascular calcification. Bone resorption, the most frequent alteration of CRI, occurs in several locations (subperiosteal, subchondral, trabecular, endosteal, and subligamentous), whereas brown tumors and periosteal reaction are much less common. Osteosclerosis primarily affects the axial skeleton and may be the only sign of CRI. Osteoporosis and osteomalacia cause osteopenia and are not infrequent changes of CRI. The prevalence of calcifications increases with the duration of hemodialysis. The other major group of musculoskeletal abnormalities attributable to CRI includes aluminum deposition, amyloid deposition and destructive spondyloarthropathy, tendon rupture, crystal deposition, infection, and avascular necrosis. These changes are less common than those of renal osteodystrophy and are more frequently seen in patients who have undergone long-term hemodialysis or renal transplantation. Recognition of musculoskeletal manifestations is important in the clinical management of patients with CRI.
慢性肾功能不全（CRI）患者中涉及肌肉骨骼系统的异常情况众多且常见。CRI最常见的放射学表现统称为肾性骨营养不良：继发性甲状旁腺功能亢进（骨吸收、骨膜反应和棕色瘤）、骨质疏松、骨硬化、骨软化以及软组织和血管钙化的表现。骨吸收是CRI最常见的改变，可发生于多个部位（骨膜下、软骨下、小梁、骨内膜和韧带下），而棕色瘤和骨膜反应则较为少见。骨硬化主要影响中轴骨骼，可能是CRI的唯一征象。骨质疏松和骨软化会导致骨质减少，也是CRI常见的改变。钙化的发生率随血液透析时间延长而增加。CRI导致的另一类主要肌肉骨骼异常包括铝沉积、淀粉样沉积和破坏性脊椎关节病、肌腱断裂、晶体沉积、感染和缺血性坏死。这些改变比肾性骨营养不良少见，在长期接受血液透析或肾移植的患者中更常见。认识肌肉骨骼表现对CRI患者的临床管理很重要。
