骨科英文书籍精读（49）｜骨折晚期并发症之病理骨折（1）
PATHOLOGICAL FRACTURES
When abnormal bone gives way this is referred to as a pathological fracture. The causes are numerous and varied; often the diagnosis is not made until a biopsy is examined (Table 23.5).
HISTORY
Bone that fractures spontaneously, or after trivial injury, must be regarded as abnormal until proved otherwise. Older patients should always be asked about previous illnesses or operations. A malignant tumour, no matter how long ago it occurred, may be the source of a late metastatic lesion; a history of gastrectomy, intestinal malabsorption, chronic alcoholism or prolonged drug therapy should suggest a metabolic bone disorder.
Symptoms such as loss of weight, pain, a lump, cough or haematuria suggest that the fracture may be through a secondary deposit.
In younger patients, a history of several previous fractures may suggest a diagnosis of osteogenesis imperfecta, even if the patient does not show the classic features of the disorder.
EXAMINATION
Local signs of bone disease (an infected sinus, an old scar, swelling or deformity) should not be missed. The site of the fracture may suggest the diagnosis: patients with involutional osteoporosis develop fractures of the vertebral bodies and corticocancellous junctions of long bones; a fracture through the shaft of the bone in an elderly patient, especially in the subtrochanteric region, should be regarded as a pathological fracture until proved otherwise.
General examination may be informative. Congenital dysplasias, fibrous dysplasia, Cushing’ syndrome and Paget’ disease all produce characteristic appearances. The patient may be wasted (possibly due to malignant disease). The lymph nodes or liver may be enlarged. It should be noted whether there is a mass in the abdomen or pelvis. Old scars should not be overlooked and rectal and vaginal examinations are mandatory.
Under the age of 20 the common causes of pathological fracture are benign bone tumours and cysts. Over the age of 40 the common causes are multiple myeloma, secondary carcinoma and Paget’s disease.
---from 《Apley’s System of Orthopaedics and Fractures》P726
重点词汇整理：
malignant tumour恶性肿瘤 /məˈlɪɡnənt/n. 保王党员；怀恶意的人adj. [医] 恶性的；有害的；有恶意的
a late metastatic lesion晚期转移性病灶
gastrectomy /gæs'trɛktəmi/n. [外科] 胃切除术
intestinal malabsorption, chronic alcoholism肠道吸收不良、慢性酒精中毒
metabolic bone disorder.骨代谢障碍
metabolic /ˌmetəˈbɑːlɪk/adj. 变化的；新陈代谢的;代谢的
metastatic/ˌmetəˈstætɪk/adj. （癌细胞的）转移性的；变形的；新陈代谢的
haematuria /,hi:mə'tjuəriə, ,hem-/n. 血尿；血尿症
deposit. /dɪˈpɑːzɪt/n. 存款；押金；订金；保证金；沉淀物vt. 使沉积；存放
osteogenesis imperfecta /,ɔstiəu'dʒenisis/ /,impə'fektə/[外科] 成骨不全症
sinus /ˈsaɪnəs/n. [生物] 窦；窦道;静脉窦；下陷或凹下去的地方
involutional osteoporosis退化性骨质疏松症
involution/,ɪnvə'lʊʃən/n. [生物] 退化；
corticocancellous皮髓质的(皮质松质骨)
subtrochanteric region转子下区域
informative /ɪnˈfɔːrmətɪv/adj. 提供有用信息的；教育性的
Congenital dysplasias先天性发育异常
Congenital/kənˈdʒenɪtl/adj. 先天的，天生的；天赋的
dysplasia /dɪs'pleʒə/n. 发育不良；发育异常；异常结构
fibrous dysplasia纤维性结构不良
Cushing’ syndrome 库欣综合征
The patient may be wasted病人可能会消瘦
mass/mæs/n. 块，团；群众，民众；大量，众多；质量adj. 群众的，民众的；大规模的，集中的
mess /mes/n. 混乱；食堂，伙食团；困境；脏乱的东西vt. 弄乱，弄脏；毁坏；使就餐
overlooked忽略；不理会；宽恕
rectal and vaginal直肠和阴道 /ˈrektəl//vəˈdʒaɪnl/
mandatory /ˈmændətɔːri/n. 受托者（等于mandatary）adj. 强制的；托管的；命令的
benign bone tumours and cysts良性骨肿瘤和囊肿
benign /bɪˈnaɪn/adj. 良性的；和蔼的，亲切的；吉利的
multiple myeloma多发性骨髓瘤/ˌmaɪəˈloʊmə/
secondary carcinoma 继发性癌
谷歌医学翻译：
病理骨折
当异常的骨骼屈服时，这被称为病理性骨折。病因多种多样，通常直到活检检查后才能做出诊断(表23.5)。
病史
自发性骨折或轻微损伤后的骨骼必须被认为是异常的，除非另有证明。年长的患者应该总是被问及以前的疾病或手术情况。恶性肿瘤，无论发生在多长时间以前，都可能是晚期转移病灶的来源；有胃切除术、肠道吸收不良、慢性酒精中毒或长期药物治疗的病史应提示代谢性骨骼疾病。
体重减轻、疼痛、肿块、咳嗽或血尿等症状表明骨折可能是通过二次沉积造成的。
在较年轻的患者中，以前的几次骨折史可能提示诊断为成骨不全，即使患者没有表现出这种疾病的典型特征。
检查
骨病的局部征象(感染的鼻窦、陈旧的疤痕、肿胀或畸形)不应被遗漏。骨折的部位可提示诊断：退化性骨质疏松症患者出现椎体骨折和长骨的皮质松质连接；老年患者的骨干骨折，特别是粗隆下区域的骨折，应视为病理性骨折，除非有其他证明。
一般检查可能会提供信息。先天性发育不良、纤维发育不良、库欣综合征和Paget病均有特征性表现。病人可能会虚度(可能是由于恶性疾病)。淋巴结或肝脏可能增大。需要注意的是，腹部或骨盆是否有肿块。旧疤痕不可忽视，直肠和阴道检查是强制性的。
20岁以下病理性骨折的常见原因是良性骨肿瘤和囊肿。40岁以上的常见病因是多发性骨髓瘤、继发性癌症和佩吉特氏病。