This standard specifies the diagnostic criteria and treatment principles for external radiation-induced bone injury. This standard applies to radiation workers (including emergency personnel) with bone injury caused by occupational radiation. Bone injury caused by non-occupational radiation can also be diagnosed and treated with reference to this standard. GBZ 100-2002 Diagnostic criteria for external radiation-induced bone injury GBZ100-2002 Standard download decompression password: www.bzxz.net

ICS13.100
National occupational health standard of the People's Republic of China GBZ100—2002
Diagnostic criteria for external radiation bone injuries
Diagnostic criteria for external radiation bone injuries2002—04-08 Issued
Ministry of Health of the People's Republic of China
Implementation on 2002—06-01
Chapter 3, 4 and 5.1 of this standard are mandatory, and the rest are recommended. GBZ100-2002
This standard is specially formulated in accordance with the "Law of the People's Republic of China on the Prevention and Control of Occupational Diseases". In case of any inconsistency between the original standard GB16389-1996 and this standard, this standard shall prevail.
Appendix A of this standard is an informative appendix.
This standard is proposed and managed by the Ministry of Health of the People's Republic of China. Drafting unit of this standard: Affiliated Hospital of the Academy of Military Medical Sciences of the Chinese People's Liberation Army. The main drafters of this standard are: Yang Zhixiang, Chen Zhong, Wang Fangxin, Li Fengwei, Ye Genyao. The Ministry of Health of the People's Republic of China is responsible for the interpretation of this standard. 1. ScopewwW.bzxz.Net
Diagnostic criteria for external radiation bone injury
This standard specifies the diagnostic criteria and treatment principles for external radiation bone injury GBZ100-2002
This standard applies to radiation workers (including emergency personnel) with bone injury caused by occupational radiation. Bone injury caused by non-occupational radiation can also be diagnosed and treated with reference to this standard. 2. Terms and definitions
The following terms and definitions apply to this standard. 2.1 Radiation bone injury radiationboneinjuries A series of metabolic and clinical pathological changes in bone tissue caused by the whole body or part of the human body being exposed to a single or short-term high-dose external radiation or long-term multiple external radiation exceeding the dose equivalent limit. According to its pathological changes, it is divided into osteoporosis, osteomyelitis, pathological fracture, osteonecrosis and bone development disorder. 2.2 Radiation osteoporosis: After the bone tissue is exposed to ionizing radiation, the bone cells degenerate and die, resulting in a series of pathological changes characterized by decreased bone density. 2.3 Radiation osteomyelitis: After the bone tissue is exposed to a certain dose of ionizing radiation, secondary bacterial infection occurs on the basis of osteoporosis, resulting in inflammatory changes. 2.4 Radiation fracture: After the bone tissue is exposed to osteoporosis and osteomyelitis, the bone continuity is destroyed. 2.5 Radioactive osteonecrosis: After the bone tissue is exposed to ionizing radiation, the bone cells or bone nutrient blood vessels are damaged, and the blood circulation is impaired, resulting in the necrosis of bone blocks or bone fragments.
2.6 Radiation dysostosis: After the bone cartilage is exposed to ionizing radiation, the growth and development of the bone is impaired, making the length and circumference of the bone smaller than that of the normally developed bone tissue.
3. Diagnostic principles
A comprehensive analysis must be conducted based on the history of exposure, exposure dose, dose rate, clinical manifestations, X-ray imaging or bone density measurement, and bone diseases caused by other reasons must be excluded before diagnosis can be made. 4. Classification diagnosis basis
GBZ100-2002
For bone damage within the exposure range (or irradiation field) caused by a single or multiple high-dose irradiation of a part of the body within a short period of time (several days), the reference threshold for bone damage dose is 20Gy; for bone damage caused by long-term exposure to radiation, the reference threshold is 50Gy. 4.1 Radioactive osteoporosis.
4.1.1 Often accompanied by local skin radiation dermatitis changes. 4.1.2 X-ray signs: In mild cases, the trabeculae are sparse and rough; in severe cases, the trabecular mesh is sparse, with patchy translucent areas, and the bone cortex is significantly thickened in a lamellar shape or the white line of the cortex disappears. 4.2 Radiation osteomyelitis
4.2.1 Often accompanied by ulcers of local skin and soft tissue deep into the bone, often accompanied by varying degrees of bacterial infection. 4.2.2 X-ray signs: decreased density and thinning of the bone cortex, rough surface, irregular destruction of the bone accompanied by osteoporosis nearby and irregular patchy translucent areas, occasionally accompanied by bone hyperplasia or dead bone formation. 4.3 Radioactive fractures
4.3.1 This type of fracture is a pathological fracture secondary to radiation bone damage (osteoporosis, osteomyelitis, osteonecrosis). 4.3.2 There is radiation dermatitis or ulcers on the local skin. 4.3.3 Before the fracture occurs, there are generally varying degrees of excessive activity, external force and other predisposing factors, but sometimes the predisposing factors are not obvious. 4.3.4 Fractures often occur in weight-bearing bones (vertebral bodies, femoral necks, radial heads, visceral bones, clavicles and ribs, etc.). 4.3.5 X-ray signs: There is osteoporosis as a basis, and both ends of the fracture have osteoporotic changes. The fracture line is generally neat. 4.4 Osteonecrosis
4.4.1 It often occurs on the basis of bone atrophy, osteomyelitis or fracture. 4.4.2 It is accompanied by severe radiation damage to local skin and soft tissue. 4.4.3 X-ray signs: Irregular, flaky, dense shadows appear in the osteoporotic area or near the fracture ends, interspersed with some translucent areas.
4.5 Radioactive bone development disorder
4.5.1 It is often seen in children whose bones are actively proliferating when irradiated (about 6 years old or adolescent children). 4.5.2 There may be no obvious radiation damage changes in the local skin, or there may be mild radiation dermatitis changes. 4.5.3 X-ray signs: Bone and cartilage growth is slow or even stagnant. Long bones have obstacles in both longitudinal and transverse growth, shortening in length, thinning of the bone shaft, and thinning of the cortex. 5. Treatment principles
5.1 For those whose local radiation dose has been determined to exceed the reference threshold dose for bone injury, whether or not there is clinical or X-ray manifestation of bone injury, they should be separated from the radiation. Those with bone injury should be separated from the radiation, or switched to non-radioactive work according to their general condition. 5.2 To prevent and reduce the occurrence of radiation-induced bone injury, a diet rich in calcium and protein should be given, and proper exercise should be taken. 5.3 Drugs that improve microcirculation and promote bone tissue repair and regeneration should be used: such as compound danshen, glutathione, ascorbic acid, calcitonin, vitamin A, vitamin D, protein anabolic hormones such as stanozolol, and calcium-containing preparations. 5.4 Hyperbaric oxygen therapy can also be used if conditions permit. 5.5 Pay attention to avoid trauma or infection of the bone injury site, avoid biopsy, and promptly treat and take surgical treatment when obvious skin atrophy or ulceration occurs, and cover with a flap or muscle flap with good blood circulation to improve local blood circulation and eliminate the wound surface. 5.6 When osteomyelitis occurs, anti-infection treatment should be given, and surgical treatment should be taken in time to completely remove necrotic bone, fill the cavity with vascularized muscle flaps and repair the wound surface. 5.7 When osteomyelitis occurs in a single phalanx or toe, the finger (toe) should be amputated in time. If multiple fingers (toes) are accumulated and the remaining individual fingers (toes) are no longer functional, amputation can be considered, but it should be done with caution. The height of the amputation should exceed the proximal end of the injury by 3 to 5 cm. Appendix, A
Instructions for the correct use of this standard
(Informative Appendix)
GBZ100-2002
A.1 The purpose of this standard is to enable personnel who suffer bone injuries due to local external exposure exceeding the dose equivalent limit to receive timely and correct diagnosis and treatment, prevent the progression of the disease, and promote recovery. A.2 Radioactive bone injury is a deterministic effect, and there is a dose threshold. However, due to the different energies of various rays, different exposure conditions, different thicknesses of soft tissues in different parts of the body, and different post-exposure treatments, it is currently difficult to determine an accurate universal threshold dose. The exposure dose threshold for bone injury given in this standard is only a reference value range. A.3 The degree of bone injury is related to factors such as the nature of the radiation source, exposure dose, dose rate, number of exposures, interval time, exposure site and range. Those with large exposure doses, short intervals, and large ranges will appear earlier and have a more severe degree. A single high-dose exposure is more severe than multiple small-dose exposures.
A.4 Osteoporosis, osteomyelitis, pathological fractures, and bone necrosis are a development and evolution of injury. The degree of bone injury and changes in X-ray signs are consistent with the exposure dose and the time after exposure. At the same time, it is also related to whether the treatment and protection of the irradiated area are appropriate.
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