Looser zone of perestroika


Looser area of perestroika (arrow) in osteodystrophy.

Looser zone of perestroika (synonym Looser zone enlightenment) - pathological condition of the bone, resulting from the increased load on healthy or normal load on the modified bone. Looser zone adjustment on radiographs appear strip enlightenment (Fig.), intersect transversely part or all of the bone, which can be accompanied by pain and swelling. Looser zone of perestroika are found mainly in metatarsal (see Marching foot), femur and tibia bones, ribs and collarbone.

Looser zone of perestroika (that is Looser; synonym Looser zone of enlightenment), a kind of pathological structural changes of bone tissue, which is manifested in appearance of the x-ray, mainly of long tubular bones, transparent parts of enlightenment, of loss of bone substance (Fig. 1-3).
In most cases, L. C. p. see as line, bar or tape of a width of a few millimeters crossing (in the form of a zone of increased transparency) diaphysis or mutatis tubular bones. Area permeates cortical and cancellous in all width of the bone or (more often) in the form of a wedge-shaped notches is only a part of its diameter. L. Z. p. oriented either strictly perpendicular to the long axis of the bone or to the convex surface of the cortical layer or several obliquely. Sometimes L. C. p. several winding or sawtooth serrated. Light strip bordered more or less pronounced osteosclerosis. L. Z. p. may be a wedge or even rounded.
To Looser areas of restructuring must be attributed to the so-called gap shadows, i.e. limited semioval bugliarisi regional (marginal) surface defects core substance of the typical places, mostly in the tibial and femoral bone. On the surface of the bone around D. C. p. develops periosteal reactive process in the form of small staple, perekidyvaetsya through the zone of enlightenment, or rather I. pronounced layered or solid periosteal dense growth. Noticeable shifts bone parts, separated area of the enlightenment, in uncomplicated L. C. p. does not happen.
L. Z. p. result of high mechanical and static-dynamic load mainly on the parts of the skeleton, subject to the maximum power input extension. They are considered as a temporary anatomic-functional failure of the bone as a body, as the process of its pathological perestroika.
Looser zone adjustment observed, first, in the bones obviously healthy, without any prior pathological process. The most telling example of this group L. C. p. serves as the restructuring of one of the metatarsal bones in March foot (see), as well as the so-called trench periostitis in young soldiers and untrained athletes, i.e. all large group of pathological rebuild bones, dedicated S. A. Nannberga in independent nosological form of bone diseases.
Secondly, especially pronounced L. C. p. (often plural) as symptomatic manifestations in the skeleton in patients with systemic bone disease [rickets, renal, or E. fibrosa, osteodystrophies giperparatireoz
disease (Recklinghausen) and deforming (Paget's disease, Fig. 4), congenital imperfect osteogenesis, the outcome of polio, syringomyelia and so on]. L. Z. p. observed in projivshii bone grafts with disproportionately large load on them. Multiple L. C. p. in large tubular bones developing on the background of overall systemic osteoporosis and osteomalacia are the main symptom in the so-called osteopathy hungry and motivated (without sufficient grounds) to highlight the so-called disease Milkmen (Milkmen - Looser) in independent nosological unit.
In the basis of histologic L. C. p. is the process of resorption of bone tissue with education Stevenage substances. The bone marrow is replaced on-site destruction of fibrous connective tissue. The whole process of restructuring is completed the formation of a new full of bone and self-treatment. Any inflammatory, dystrophic, ordinary traumatic and especially blastomata changes microscopically when L. C. p. not there is a process of a special nature.
Clinical manifestations Looser areas of perestroika when the two groups are different. In the first group patients according to local pathological process have pain and swelling adjacent soft tissues due to concomitant solid edema. In the second group L. C. p. detected on the background of General systemic skeletal disease, as a rule, only unexpectedly, only when chest x-ray, and local violations usually not accompanied.
L. Z. p. are in x-rays and bone disorders very large differential diagnostic value. The main practical goal is the elimination of fractures, cracks and generally traumatic disorders of the bones intact, as the area of enlightenment can be similar to the line of the fracture.
Importantly, L. C. p. history no indication of an injury, i.e., a sharp single short application excessive mechanical force. Differential diagnosis can be especially difficult if L. C. p. complicated by consistently coming true fracture with displacement of bone fragments. All other diseases inflammatory, dystrophic, neurogenic and blastomycosis character usually excluded easily.
Treatment Looser areas of perestroika when both groups of different diseases. It does address the external mechanical factor in the first group and therapeutic effect on the underlying disease - in the second.
Explicitly excluded surgery. The prediction is quite good, and x-ray dynamic control over the months invariably shows the disappearance L. C. p. with the restoration of a more or less normal bone structure in its place.

Fig. 1. Looser area of perestroika in the cortical layer of the tibia in the form of strips of depression, simulating a partial reversal (the arrow).
Fig. 2. Violation of the integrity of bone tissue hips with mutual displacement of fragments in the presence Looser zone of perestroika in the neck of the femur.
Fig. 3. Looser area of restructuring of the tibial diaphysis, resembling the picture of the cortical bone).
Fig. 4. Looser area of restructuring of the tibia in deforming osteodystrophies (Paget's disease).