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摘要 慢性复发性多病灶性骨髓炎(Chronic recurrent multiple osteomyelitis,CRMO),又名慢性非细菌性骨髓炎(Chronic nonbacterial osteomyelitis,CNO),是一种罕见的自身炎症失调性疾病,具有疼痛反复发作与缓解的病程特征,该疼痛与无菌性骨骼炎症相关。流行病学调查研究显示该病的发病率为1/1 000 000~2/1 000 000,双下肢长骨为其好发部位,脊椎骨、锁骨、颅骨等也常会涉及。Giedion等于1972年首次描述了四位患有亚急性或慢性骨髓炎的病例,这四位患者的病灶均为多发、对称分布,且多靠近长骨的生长板。随后有学者也描述了表现相似的病例,并予以“慢性复发性多病灶性骨髓炎”这一诊断术语。CRMO疾病目前归属于以慢性非感染性骨髓炎为特征的疾病群组,该疾病群组还包括滑膜炎、痤疮、脓疱病、骨肥厚和骨髓炎(synovitis acne pustulosis hyperostosis osteomyelitis,SAPHO)综合征,马吉德综合征、白细胞介素1受体拮抗剂缺乏以及家族性巨颌症等。任何年龄段均可发生SAPHO综合征,而常表现为反复发作和缓解,且女性发病率稍高于男性。因为SAPHO综合征的临床表现各异,所以该疾病的诊断较为困难,而该病一经确诊,则需长期随访以防止并发症的发生,但有研究结果表明SAPHO综合征的预后一般较好。学者们到目前为止仍不能确定CRMO和SAPHO综合征是否是同一疾病在不同发病年龄阶段的不同表现形式或是否是同一疾病不同临床表现的不同结局。本文对CRMO的临床特征、影像学检查特点、发病机理、疾病预后、疾病分类以及诊断和处理等方面进行了综述。
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作者简介: 张祥洪(1989- ),男,主治医师,广西科技大学附属柳州市人民医院骨科,545006。 |
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