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上期试题：骨囊肿的治疗原则是B A．截肢 B．观察，不必手术 C．囊壁彻底骨切除+植骨 D．病段切除+植骨 E．囊壁刮除十囊腔内液体引流 患者，女，56岁，腰疼伴右下肢麻痛3个月，加重1周。 查体：腰骶部压痛，以右侧为著，叩痛并向右下肢放射。右下肢皮肤自大腿中下段以远感觉减退，双下肢肌力、肌张力正常。右侧膝腱跟腱反射亢进，左侧正常。 ↑颅骨和骨盆X线平片： 颅面骨及骨盆多发类圆形骨质密度减低区，边界清楚，未见软组织肿块。 ↑CT平扫： 左侧部分肋骨局部膨胀性骨质破坏，部分椎体及椎弓根骨质破坏，其内可见软组织密度影，密度均匀。 ↑矢状位T1WI、矢状位T2WI抑脂像、胸椎横轴位T2WI抑脂像、骨盆横轴位T2WI抑脂像： 下胸椎、腰椎、骶椎椎体及附件、髂骨内可见弥漫性大片状、团块状骨质破坏区，呈长T1、长T2信号影，T2WI抑脂像上呈高信号，部分骨皮质破坏、中断，周围可见软组织肿块。 ↑全身DWI成像： 脊柱椎体及附件、肋骨、肱骨、肩胛骨、胸骨、髂骨、耻坐骨及股骨内可见多发斑点状、结节状异常弥散信号灶。 骨髓瘤是浆细胞异常增殖的恶性肿瘤，由于其高分化的瘤细胞类似浆细胞，又称为浆细胞瘤，约占骨恶性肿瘤6%，分为分泌型和非分泌型。本病有单发和多发之分，多发者占绝大多数，易累及红骨髓丰富的骨骼，如中轴骨和扁骨，据统计最易受累的骨骼依次为颅骨、脊椎、肋骨、骨盆和长骨干骺端。临床表现复杂，可表现为全身骨痛、软组织肿块、病理骨折，急慢性肾功能衰竭，反复感染，贫血等。多发性骨髓瘤对椎体及其附件的破坏是引起早期症状的主要原因。实验室检查血清M蛋白阳性、尿本-周蛋白阳性，骨髓涂片可找到骨髓瘤细胞。 Myeloma is abnormal plasma cells proliferation of malignant tumor, due to its high differentiation of tumor cells similar to plasma cells, also known as plasma cell tumors, accounts for about 6% of malignant bone tumors, divided into production and secretion. The disease has the points of single and multiple, multiple accounts for the vast majority, easy involvement rich red marrow bones, such as axial skeleton and flat bones, according to statistics, the most easily affected bone of skull and spine, ribs, pelvic and long bone epiphysis end. Clinical manifestations are complicated, which can be manifested as systemic bone pain, soft tissue mass, pathological fracture, acute and chronic renal failure, recurrent infection, anemia, etc. The damage of multiple myeloma to vertebral body and its annex is the main cause of early symptoms. The serum M protein was tested positive in the laboratory, and the urinary-weekly protein was positive, and myeloma cells were found in bone marrow smear. 不同类型、不同部位的骨髓瘤其影像学表现各不相同，早期X线平片可无异常，或仅为普遍性骨质疏松，无骨质破坏。发生于扁平骨者，骨质破坏以虫蚀样、斑片状改变为主，颅骨破坏以穿凿样改变为主，四肢管状骨以大片溶骨性改变为主。CT较X线平片能更好的显示骨内肿瘤的范围、骨质疏松和骨外侵犯的程度。骨质破坏或骨髓浸润区在MRI检查T1WI像上呈边界清楚的低信号，多位于中轴骨及四肢骨近端，于T2WI像上，多发、散在的点状低信号病灶分布于高信号的骨髓背景内时呈特征性‘盐和胡椒征’。 Different types and different parts of myeloma have different imaging manifestations, and early X-ray plates may not be abnormal, or have no bone damage. It was found in the flat bone, the bone destruction was mainly insect-like, specular change, and cranial damage was mainly based on the change of the perforated sample, and the tubular bone of the extremities was dominated by a large number of osteolytic changes. CT is better than X-ray and can show the extent of bone tumor, osteoporosis and bone invasion. Bony destruction or bone marrow infiltration area in MRI T1WI low signal on like a border clear, located in the axial skeleton and four limbs which proximal, on T2WI like, multiple, dotted with low signal intensity distribution in high signal characteristic of bone marrow in the background is' salt and pepper). 多发性骨髓瘤影像学表现在骨髓病变中较有特征性，但确诊仍需结合骨髓穿刺活检以及实验室检查。 The imaging findings of multiple myeloma are more characteristic in bone marrow lesions, but the diagnosis still needs to be combined with bone marrow biopsy and laboratory examination. 本例应与多发溶骨习性骨转移瘤鉴别。溶骨性转移瘤的病灶大小差别较大，一般不伴有骨质疏松，发生于脊柱者较骨髓瘤更易累及双侧椎弓根，周围软组织肿块较大，胸部CT经常可以查找到原发灶或转移灶；而多发性骨髓瘤的病灶较小且大小较一致，常伴有骨质疏松，发生于脊柱者主要累及椎体及棘突，边界较清，周围软组织肿块较小，尿本-周蛋白呈阳性。 This example should be identified with the bone metastatic bone metastasis. Soluble osseous metastatic lesion size difference is bigger, is generally not associated with osteoporosis, occurs in the spine was myeloma more involving bilateral pedicle, surrounding soft tissue mass is bigger, the chest CT can often find the primary tumors or metastases; And lesions of multiple myeloma and smaller size is consistent, often accompanied by osteoporosis, occurs in the spine is mainly involved vertebral body and spine, the boundary is clear, the surrounding soft tissue mass is small, urine protein this week - was positive. 本期试题：下列对多发性骨髓瘤诊断有重要意义的是？ A、蛋白尿和血尿 B、尿中检出本-周蛋白 C、血肌酐及尿素氮测定异常 D、血尿酸升高 E、IgG升高 |
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