McCarthy E F
Department of Pathology and Orthopedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Iowa Orthop J. 1998;18:35-42.
Biopsy specimens from 19 patients with transient regional osteoporosis were studied. All patients presented with pain. There were nine patients with transient osteoporosis of the hip. Six of these specimens were therapeutic core biopsies, and three were femoral heads removed during total hip replacement. The other patients with osteoporosis in different locations had biopsies to rule out infection or neoplasm. Five of these patients had transient osteoporosis of the knee. Three had ankle involvement and two had involvement of the tibial shaft. Plain radiographs were available for study in all cases, and either a bone scan or an MRI was studied in each case. Except for one patient who was lost to follow-up, all had resolution of symptoms and radiographic changes. The histologic changes in the biopsies were distinctive, although they were present in varying degrees. There was edema and reactive bone formation in the marrow spaces. In addition, osteoclastic bone resorption was active in 14 of the 19 cases. Although lipid cysts were sometimes found in the marrow spaces, there was no evidence of fat necrosis or bone necrosis. The high bone turnover and absence of fat necrosis suggests that this disorder is a vasomotor response rather than an early stage of osteonecrosis. Awareness of these characteristic histologic changes should enable the pathologist to make a specific diagnosis of transient regional osteoporosis when a biopsy is required.
对19例短暂性区域性骨质疏松症患者的活检标本进行了研究。所有患者均有疼痛症状。其中9例为髋部短暂性骨质疏松症。这些标本中有6例是治疗性核心活检标本，3例是全髋关节置换术中切除的股骨头。其他不同部位骨质疏松症患者进行活检以排除感染或肿瘤。其中5例为膝关节短暂性骨质疏松症。3例累及踝关节，2例累及胫骨干。所有病例均有X线平片可供研究，每个病例均进行了骨扫描或磁共振成像（MRI）检查。除1例失访患者外，所有患者症状及影像学改变均消失。活检标本中的组织学改变具有特征性，尽管程度不同。骨髓腔内有水肿和反应性骨形成。此外，19例中有14例破骨细胞性骨吸收活跃。虽然骨髓腔内有时可见脂质囊肿，但无脂肪坏死或骨坏死的证据。高骨转换率及无脂肪坏死提示该疾病是一种血管舒缩反应，而非骨坏死的早期阶段。当需要进行活检时，了解这些特征性组织学改变应能使病理学家对短暂性区域性骨质疏松症做出明确诊断。
