Loozer of a zone of reorganization (a synonym for Loozer of a zone of enlightenment) is a pathological condition of a bone resulting from an increased load on a healthy or normal load on an altered bone. Loozer zone adjustment on radiographs appear a strip of enlightenment (Fig.), Crossing across part or all of the bone, which may be accompanied by pain and swelling. Loozer zone adjustment are found mainly in the metatarsal (see marching foot), femoral and tibial bones, ribs and collarbone.
Loozer zone adjustment (arrow) with osteodystrophy.
Loozer zone adjustment (E. Looser; synonym Loozer zone of enlightenment) - a kind of pathological structural changes in bone tissue, reflected in the appearance on radiographs, mainly long tubular bones, transparent areas of enlightenment, loss of bone matter (Fig. 1-3).Go
In the overwhelming majority of cases, the Loozer restructuring zones are depicted as a line, strip or ribbon several millimeters wide, intersecting (as an enhanced transparency zone) the diaphysis or the metaphysis of the tubular bone. The zone penetrates the cortical and spongy substance over the entire width of the bone, or (more often) in the form of a wedge-shaped incision - only a part of its diameter. The Loozer restructuring zone is oriented either strictly perpendicular to the long axis of the bone or to the convex surface of the cortical layer, or somewhat obliquely. Sometimes the Loozer restructuring zone is somewhat tortuous or serrated. The light strip is bordered by more or less pronounced osteosclerosis. Loozer restructuring zone may be wedge-shaped or even rounded.
The so-called lacunary shadows should also be attributed to Loozer's zones of adjustment, i.e., limited semi-oval crown-like marginal (marginal) surface defects of the cortex in typical places, most often in the tibial and femoral bones. A periosteal reactive process develops on the surface of the bone around the Loozer restructuring zone in the form of a small staple that spreads over the enlightenment zone, or rather I. a pronounced layered or solid periosteal dense growth. There is no noticeable displacement of the bone areas separated by the zone of enlightenment in uncomplicated zones of Loozer restructuring.
Loozer restructuring zones arise as a result of increased mechanical and static-dynamic loading, predominantly in the skeleton areas subjected to the maximum application of extension forces. They are considered as a temporary anatomical and functional insufficiency of the bone as an organ, as a process of its pathological restructuring.
Loozer zone adjustment are observed, firstly, in the bones of knowingly healthy, without any previous pathological process. The most illustrative example of this group of Loozer restructuring zones is the restructuring of one of the metatarsal bones in the march foot (see), as well as the so-called trench periostitis in young soldiers and untrained athletes, that is, the entire large group of pathological bone remodeling, highlighted C. And Rennberg in an independent nosological form of bone diseases.Go
Secondly, Loozer restructuring zones (often multiple) are especially pronounced as symptomatic manifestations in the skeleton in patients with systemic bone disease [rickets, renal or intestinal osteodystrophy, hyperparathyroid osteodystrophy (Recklingausen's disease) and deforming (Paget's disease, Fig. 4) , congenital imperfect osteogenesis, outcome of polio, syringomyelia, etc.]. Loozer restructuring zones are also observed in adherent bone grafts with disproportionately large loads on them. Multiple zones of Loozer restructuring in large tubular bones, developing against the background of general systemic osteoporosis or osteomalacia, are the leading symptom of the so-called osteopathy of the starving and induced (without sufficient reason) to isolate the so-called Milkman's disease (Milkmen-Loozer) into an independent nosological unit.
The basis of the histological picture of the Loozer restructuring zone is the process of resorption of bone tissue with the formation of osteoid substance. The bone marrow is replaced at the site of the lesion by fibrous connective tissue. The whole process of restructuring is completed by the formation of a new full-fledged bone tissue and self-healing. There are no microscopic inflammatory, dystrophic, usual traumatic and especially blastomatous changes in the zones of Loozer restructuring - this is a process of a special nature.
The clinical manifestations of Loozer's adjustment zones are different for both groups. In the first group of patients, according to the local pathological process, there are pains and swelling of the adjacent soft tissues due to concomitant hard edema. In the second group L. h. the n. are found against the background of the general systemic skeletal disease, as a rule, only unexpectedly, only during X-ray examination, and are usually not accompanied by local disorders.
L. h. have radiodiagnosis of bone diseases of very large differential diagnostic value. The main practical task is to exclude a fracture, a crack, and generally a traumatic violation of bone integrity, since the zone of enlightenment can have a great resemblance to the fracture line.
It is important that when L. h. In the history there is no indication of injury, i.e., a sharp one-time short-term application of excessive mechanical force. Differential diagnostics can become especially difficult if L. z. the procedure is complicated by the successive true fracture of the bone with the displacement of fragments. All other diseases of inflammatory, dystrophic, neurogenic and blastomatous nature are usually excluded easily.
Loozer treatment of zones of adjustment in both groups of diseases is different. It is aimed at eliminating the external mechanical factor in the first group and at therapeutic effects on the underlying disease - in the second.
Strictly excluded surgical intervention. The prediction is quite favorable, and radiological dynamic monitoring during the months invariably shows the disappearance of L. h. with restoration of more or less normal bone structure in its place.
Fig. 1. Loozer zone adjustment in the cortical layer of the tibia in the form of a strip of rarefaction, imitating an incomplete fracture (indicated by an arrow).
Fig. 2. Violation of the integrity of the bone tissue of the femur with the mutual displacement of fragments in the presence of Loozer of the zone of adjustment in the neck of the femur.
Fig. 3. Loozer The zone of restructuring of the tibial diaphysis resembling a picture of a cortical abscess.
Fig. 4. Loozera zone of tibial restructuring with deforming osteodystrophy (Paget's disease).