METHOD FOR DIFFERENTIAL DIAGNOSTICS BETWEEN OSTEOGENIC AND BONE MARROW SARCOMAS, GIANT-CELL TUMOR AND INFLAMMATORY DISEASES OF LONG TUBULAR BONES

摘要

FIELD: medicine, orthopedics, differential diagnostics. SUBSTANCE: one should carry out a full-size roentgenography of affected limb's segment in two mutually perpendicular projections. Roentgenographic studying is supplemented with a purposeful ultrasound scanning to detect the most characteristic signs for every of these diseases. For osteogenic sarcoma it is characteristic to detect active tumor osteogenesis as a palisade of spicules developed as a result of tumor - analogs of modified haversian canals and osteons in combination with reactive, periosteal osteogenesis which develops short fragment of exfoliated and calcified periosteum - Codmen's "peak", intensive neonagiogenesis - characteristic morphological peculiarity of lytic and mixed form of this sarcoma is proved due to ultrasound angiography in the course of which one should visualize blood cavities and vessels of different diameter with curved pathway in central and peripheral departments of osteosarcoma, most of them are localized to be parallel to spicules. Young's sarcoma is of diffusion-heterogeneous structure with foci of reactive osteogenesis and develops exfoliated periosteosis, surface tumor departments have lower echogeneity; active tumor osteogenesis is not observed. Giant-cell tumor is of relatively homogeneous structure; one should determine incompletely lysed osseous trabecules in the thickness; tumor vascularization is intensive, however, vascular architectonics is less curved and chaotic than in sarcomas. In case of acute osteomyelitis in children it is necessary to visualize periosteal exfoliation, in grown-ups one should detect purulent liquid outwards against periosteum. At chronic osteomyelitis one should detect granulation tissue outwards against exfoliated periosteum. For all forms of development it is characteristic the presence of cylindrical defects in periosteum and cortical layer. The present method enables to obtain diagnostic information on the character and degree of pathological process. EFFECT: higher efficiency of differential diagnostics. 54 dwg