新疆库车友谊路墓地居民溶骨性损伤的古病理学
收稿日期: 2024-07-12
修回日期: 2025-04-24
网络出版日期: 2026-08-12
基金资助
国家社会科学基金一般项目“塔里木盆地周缘古代人群体质特征的格局与演进研究”(18BKG038)
Paleopathology of a person with osteolytic injury from the Youyilu Cemetery, Kuqa, Xinjiang
Received date: 2024-07-12
Revised date: 2025-04-24
Online published: 2026-08-12
2023年，在新疆库车友谊路墓地的发掘过程中，于WM341墓主左侧胫骨发现溶骨性损伤。该个体为14~20岁的青年男性个体。损伤具体表现为左侧胫骨骨干有两处明显的虫蚀状骨损痕迹；左侧腓骨、右侧胫腓骨未发现病理现象；其余部位骨骼除部分胸椎发生黄韧带骨化之外，均未见异常。应用正置显微镜、X光和CT断层扫描等技术手段对病灶做进一步观察和分析后，结合现代临床案例研究，从流行病学和病理表现两个方面排除了急性血源性骨髓炎、低级别中央型骨肉瘤、孤立性骨囊肿、朗格汉斯细胞组织细胞增生症、恶性骨巨细胞瘤等发生的可能性。该溶骨性损伤是尤文氏肉瘤的可能性最大。尤文氏肉瘤恶性程度高，或为该个体死亡的直接死因。该案例为目前国内古代样品所见尤文氏肉瘤的首次报道。
王师慧 , 魏东 , 党志豪 . 新疆库车友谊路墓地居民溶骨性损伤的古病理学[J]. 人类学学报, 2026 , 45(04) : 695 -708 . DOI: 10.16359/j.1000-3193/AAS.2025.0079
In this paper, we focus on a male adolescent unearthed from the Youyilu Cemetery in Kuqa County, Aksu Prefecture, Xinjiang Uygur Autonomous Region. The individual was discovered in WM341, which is dated to the Song-Yuan Period. The estimated age is 14 to 20 years old. Considering the taphonomic context of the tomb, it is reasonable to regard this individual as the tomb owner. Only a set of skeletons has been found. At first glance of the bones, it is quite obvious that there are two osteolytic lesions on the left tibia shaft. The more intense one is located over the middle of the diaphysis, and the less intense one is close to the proximal end. Except for ossification of the ligamentum flavum (OLF) on parts of the thoracic vertebrae, there are no other lesions or degenerative changes on the other bones, including the left fibula and the contralateral tibia and fibula. We also employed an upright microscope, X-ray, and computed tomography (CT) to observe the microstructure of the two damages. In the upright microscope, we found typical moth-eaten marks and sclerotic lesions in the bone trabeculae. In X-ray and CT imaging analyses, we traced and distinguished primary and secondary lesions. Additionally, we attempted to dissect the transmission process on the left tibia. We concluded that the larger one in the midshaft is primary and it spreads towards the two epiphyses, while a secondary lesion forms near the proximal end. By integrating the pathological manifestations of the individual and typical clinical cases, we selected six kinds of diseases, which can be further divided into two groups. One group consists of bone tumors, including Ewing’s sarcoma (ES), low grade central osteosarcoma (LGCOS), solitary bone cyst (SBC), Langerhans cell histiocytosis (LCH), and malignant giant cell tumor (MGCT). The other is non-specific infection: Acute hematogenous osteomyelitis (AHO). The moth-eaten lesion shows some manifestations of central bone tumor, multiplicity, and osteometastasis. Through analyzing the epidemiology and pathological manifestations of the selected diseases, we conclude that it is more likely that the tomb owner of WM341 in the Youyilu Cemetery was a victim of ES. Due to the high-grade malignancy and the possibility of pulmonary metastasis secondary to osteolytic lesions, ES is more likely to be the cause of the individual’s death. The bone tumor occurring in the left tibia is worthy of being regarded as a typical case of ES in paleopathology. Based on reasonable analysis and discussion, this should be the first ES case found in ancient people and be published in detail in the field of paleopathology in China.
Key words： Youyilu Cemetery; paleopathology; osteolytic disease; bone tumor; Ewing’s sarcoma
| [1] | Ortner DJ. Identification of Pathological Conditions in Human Skeletal Remains[M]. Orlando: Elsevier Science, 2003, 503-504 |
| [2] | 邵象清. 人体测量手册[M]. 上海: 上海辞书出版社, 1985, 34-56 |
| [3] | 朱泓. 体质人类学[M]. 北京: 高等教育出版社, 2004, 92-106 |
| [4] | Buikstra JE, Ubelaker DH. Standards for data collection from human skeletal remains[M]. Fayetteville: Arkansas Archaeological Survey, 1994, 15-38 |
| [5] | 高津光洋. 法医尸检手册[M]. 北京: 人民卫生出版社, 2021, 303-327+364-367 |
| [6] | Krogman W, Iscan M. The Human Skeleton in Forensic Medicine[M]. Springfield: Charles C, Thomas, 1986, 16-43 |
| [7] | McKern T, Stewart T. Skeletal Age Changes in Young American Males, Analyzed from the Standpoint of Identification[A]. In: Technical Report EP-45[C]. Natick: Headquarters, Quartermaster Research and Development Command, 1957, 25-42 |
| [8] | Redfiled A. A New Aid to Aging Immature Skeletons: Development of the Occipital Bone[J]. American Journal of Physical Anthropology, 1970, 33: 217-220 |
| [9] | Suchey J, Owings P, Wiseley D, et al. Skeletal Aging of Unidentified Persons[A]. In: Ted A, Jane E. Human Identification: Case Studies in Forensic Anthropology[C]. Springfield: Charles C, Thomas, 1984, 278-297 |
| [10] | Ubelaker D. Human Skeletal Remains[M]. Washington DC: Taraxacum Press, 1989, 29-65 |
| [11] | Ubelaker D. The Estimation of Age at Death from Immature Human Bone[A]. In: Iscan M. Age Markers in the Human Skeleton[C]. Springfield: Charles C. Thomas, 1989, 55-70 |
| [12] | Dion E, Gmef C, Miquel A, et al. Bone involvement in erdheim-ehester disease: imaging findings including periostitis and partial epiphyseal involvement[J]. Radiology, 2006, 238(2): 632-639 |
| [13] | De Filippo M, Ingegnoli A, Carloni A, et al. Erdheim-Chester disease: clinical and radiological findings[J]. Radiologica Medica, 2009, 114(8): 1319-1329 |
| [14] | Kempson RL. Ossifying fibroma of long bones: a light and electron microscopic study[J]. Archives of Pathology, 1996, 82: 218-223 |
| [15] | Campanacci M, Laus M. Osteofibrous dysplasia of the tibia and fibula[J]. Bone and Joint Surgery, 1981, 63(3): 367-375 |
| [16] | Kyle RA, Gertz MA, Witzig TE, et al. Review of 1027 patients with newly diagnosed multiple myeloma[J]. Mayo Clinic Proceedings, 2003, 78(1): 21-33 |
| [17] | 胡聪, 匡春梅, 周文. 多发性骨髓瘤骨病发病机制的研究进展[J]. 中南大学学报(医学版), 2023, 48(9): 1403-1410 |
| [18] | 胥少汀, 葛宝丰, 徐印坎. 实用骨科学[M]. 第4版, 北京: 人民军医出版社, 2012, 1751 |
| [19] | 余建国, 姚安晋. 四肢长骨骨干结核的X线诊断(附9例报告)[J]. 实用放射学杂志, 2000, 6: 372-373 |
| [20] | Sudhir KG, Akash S, Anubhav M. Primary tuberculosis of the fibular diaphysis: A rare case report[J]. International Journal of Surgery Case Reports, 2020, 74: 140-143 |
| [21] | Mahmood M, Nassiri MC, Mohamed O, et al. Diaphyseal tuberculosis of tibia- rare occurrence: case report and review of literature[J]. Bone Reports. Recomment, 2016, 2 |
| [22] | Hsieh C, Miltner LE, Chang C. Tuberculosis of the shaft of the large long bones of the extremities[J]. Bone and Joint Surgery, 1934, 16: 545-563 |
| [23] | Ewing J. Diffuse endothelioma of bone[J]. Proceedings of the New York Pathological Society, 1921, 21(1): 17-24 |
| [24] | Sanker S, Lessnick SL. Promiscuous partnerships in Ewing’s sarcoma[J]. Cancer Genet, 2011, 204: 351-365 |
| [25] | Novik VI, Krasil LA, Kolygin BA, et al. Cytological diagnosis and prognosis in Ewing’s sarcoma in children[J]. Archives of Pathology, 2005, 67(2): 22-25 |
| [26] | Von Eisenhart R, Toepfer A, Salzmann M, et al. Primary malignant bone tumors[J]. Orthopade, 2011, 40(12): 1121-1142 |
| [27] | 李洪涛, 李董董, 杨晓笛, 等. 尤文氏肉瘤误诊为非骨化性纤维瘤1例[J]. 中国骨伤, 2017, 30(1): 68-70 |
| [28] | 王强修, 孙成良, 张光辉. 骨肿瘤诊断与治疗[M]. 北京: 中国医药科技出版社, 2010, 136 |
| [29] | 童成文, 陈光斌, 胡久民, 等. 原发性颅骨尤文氏肉瘤1例[J]. 医学影像学杂志, 2020, 30(4): 648+685 |
| [30] | 孙辉, 李邦国, 黄婷婷, 等. 原发性肋骨尤文氏肉瘤一例[J]. 临床放射学杂志, 2016, 35(5): 802-803 |
| [31] | 刘俊, 张文君, 蒋秋华. 腰椎管内原发性尤文氏肉瘤/原始神经外胚层肿瘤1例[J]. 中国临床神经外科杂志, 2023, 28(4): 287-288 |
| [32] | 吴恩惠, 张景荣, 曹来宾, 等. 放射学[M]. 北京: 人民卫生出版社, 1996, 182-184 |
| [33] | Resnick D. Diagnosis of bone and joint disorders(4th edition)[M]. Philadelphia: WB Saunders Co, 2002, 4060 |
| [34] | 张本霖, 张金祥. 尤文肉瘤早期误诊为化脓性骨髓炎1例[J]. 临床军医杂志, 2007, 8(5): 699 |
| [35] | 尧浩, 杨宜, 庞李贺, 等. 锁骨尤文氏肉瘤锁骨全切术:1例报告与综述[J]. 中国矫形外科杂志, 2021, 29(23): 2154-2156+2161 |
| [36] | Gibbs CP, Weber K, Scar borough MT, et al. Malignant bone tumors[J]. Instructional Course Lectures, 2008, 51: 413-428 |
| [37] | 田竞, 祖启明, 项良碧. 化脓性骨髓炎[J]. 中国实用乡村医生杂志, 2006, 8: 16-17 |
| [38] | Riise OR, Kirkhus E, Handeland KS, et al. Childhood osteomyelitis-incidence and differentiation from other acute onset musculoskeletal features in a population-based study[J]. BMC Pediatrics, 2008, 8(1): 45-51 |
| [39] | 胡金平. 浅析急性化脓性骨髓炎的影像诊断[J]. 当代医学, 2010, 16(15): 53-54 |
| [40] | Song KM, Sloboda JF. Acute hematogenous osteomyelitis in children[J]. The Journal of the American Academy of Orthopaedic Surgery, 2001, 9(3): 166-175 |
| [41] | 陈孝平, 汪建平, 赵继宗. 外科学[M]. 第9版, 北京: 人民卫生出版社, 2018, 738-739 |
| [42] | 刘峰. MRI在急性化脓性骨髓炎早期诊断中的应用探究[J]. 现代医用影像学, 2017, 26(2): 377-379 |
| [43] | 吴孟超, 吴在德, 黄家驷. 外科学[M]. 第7版, 北京: 人民卫生出版社, 2008, 2982-3004 |
| [44] | 胥少汀, 葛宝丰, 徐印坎. 实用骨科学[M]. 第4版, 北京: 人民军医出版社, 2012, 1557 |
| [45] | 李继承, 曾圆山, 周莉, 等. 组织学与胚胎学[M]. 第9版, 北京: 人民卫生出版社, 2018, 29 |
| [46] | 陈孝平, 汪建平, 赵继宗. 外科学[M]. 第9版, 北京: 人民卫生出版社, 2018, 776-777 |
| [47] | Unni KK, Dahlin DC, Mc Leod RA, et al. Intraosseous well-differentiated osteosarcoma[J]. Cancer, 1977, 40(3): 1337-1347 |
| [48] | Unni KK. Bone Tumors[M]. New York: Churchill Livingstone, 1988, 11: 107-133 |
| [49] | 魏清柱. WHO骨肿瘤分类[J]. 第5版,诊断病理学杂志, 2021, 28(6): 497-498 |
| [50] | Fletcher CD, Unni KK, Mertens F. World Health Organization classification of tumors: Pathology & genetics tumours of soft tissue and bone[M]. Lyon: IARC Press, 2002, 275-276 |
| [51] | 巴得热力·特尔巴图, 袁治国, 秦进, 等. 低度恶性中央型骨肉瘤的研究进展[J]. 甘肃科技, 2022, 38(21): 130-133 |
| [52] | 赵成. 低度恶性中央性骨肉瘤(LGCOS)的临床诊治分析[D]. 硕士研究生毕业论文, 济南: 山东大学, 2014, 36 |
| [53] | Kurt A, Unni K, Mc Leod R, et al. Low-grade intraosseous osteosarcoma[J]. Cancer, 1990, 65(6): 1418-1445 |
| [54] | Unni K. Case report 136. Central low-grade osteosarcoma of tibia[J]. Skeletal Radiology, 1981, 6(1): 65-71 |
| [55] | Fukunaga M. Low-grade central osteosarcoma of the skull[J]. Pathology, Research and Practice, 2005, 201(2): 131-135 |
| [56] | Diniz A, Alencar R, Garcia R, et al. Low-grade central osteosarcoma of the mandible: a case study report[J]. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2007, 103(2): 246-252 |
| [57] | Bugnone AN, Temple HT, Pitcher JD. Low-grade central osteosarcoma of the foot and ankle: radiographic and pathologic features in two patients: case report and literature review[J]. Foot Ankle International, 2005, 26(6): 494-500 |
| [58] | 易申德, 吴欣乐, 杨成茂, 等. 孤立性骨囊肿治疗的对比研究[J]. 实用医学杂志, 2017, 33(16): 2732-2735 |
| [59] | Jaffe HL, Lichtenstein L. Non-osteogenic fibroma of bone[J]. The American Journal of Pathology, 1942, 18(2): 205-221 |
| [60] | 荣独山. X线诊断学[M]. 第2版, 上海: 上海科学技术出版社, 2000, 280-281 |
| [61] | 王强修, 孙成良, 张光辉. 骨肿瘤诊断与治疗[M]. 北京: 中国医药科技出版社, 2010, 125-126 |
| [62] | 胥少汀, 葛宝丰, 徐印坎. 实用骨科学[M]. 第4版, 北京: 人民军医出版社, 2012, 1785 |
| [63] | 俎战露, 张洲, 郝晓东. 多发性孤立性骨囊肿1例[J]. 西北国防医学杂志, 2006, 6: 431 |
| [64] | 陈孝平, 汪建平, 赵继宗. 外科学[M]. 第9版, 北京: 人民卫生出版社, 2018, 779 |
| [65] | Lichtenstein L. Histocytosis: integration of eosinophilic granuloma of bone, Letterer-Siwe disease, and Schüller-Christian disease as related manifestations of a single nosologic entity[J]. Archives of Pathology, 1953, 56(1): 84-102 |
| [66] | 何平根, 侯婕妤, 王广平. 儿童局灶性朗格汉斯细胞组织细胞增生症一例[J]. 实用医技杂志, 2020, 27(2): 272-273 |
| [67] | 胥少汀, 葛宝丰, 徐印坎. 实用骨科学[M]. 第4版, 北京: 人民军医出版社, 2012, 1800 |
| [68] | 王强修, 孙成良, 张光辉. 骨肿瘤诊断与治疗[M]. 北京: 中国医药科技出版社, 2010, 205 |
| [69] | Beytemür O, Tetikkurt S, Albay C, et al. Liposclerosing myxofibrous tumor: a rare tumor of proximal femur[J]. Eklem Hastalik Cerrahisi, 2017, 28(3): 210-213 |
| [70] | Hoover KB, Rosenthal DI, Mankin H. Langerhans cell histiocytosis[J]. Skeletal Radiology, 2007, 36(2): 95-104 |
| [71] | WHO classification of tumours editorial board. Soft tissue and bone tumours, WHO classification of tumours (5th edition)[M]. Lyon: IARC Press, 2020, 321-525 |
| [72] | 赵建明, 杨军舰, 宋传涛, 等. 长骨朗格汉斯细胞组织细胞增生症的影像诊断[J]. 医学影像学杂志, 2023, 33(5): 840-842+846 |
| [73] | Rosenberg AE. WHO Classification of Soft Tissue and Bone, fourth edition: summary and commentary[J]. Current Opinion in Oncology, 2013, 25(5): 571-573 |
| [74] | Gamberi G, Serra M, Ragazzini P, et al. Indentifications of markers of possible prognostic value in 57 giant cell tumors of bone[J]. Oncology Reports, 2003, 10(2): 351-356 |
| [75] | Campanacci M, Baldini N, Boriani S, et al. Giant-cell tumor of bone[J]. Bone and Joint Surgery, 1987, 69(1): 106-114 |
| [76] | 胥少汀, 葛宝丰, 徐印坎. 实用骨科学[M]. 第4版, 北京: 人民军医出版社, 2012, 1739 |
| [77] | Roessner A, Smolle M, Hayback J. Giant cell tumor of bone: Morphology, molecular pathogenesis, and differential diagnosis[J]. Der Pathologe, 2020, 41(2): 134-142 |
| [78] | Ali N, Shah AA, Rakshan I. Clinical scenario and imaging with illustrations of giant cell tumor of bone: a retrospective analysis[J]. Archives of Bone and Joint Surgery, 2022, 10(1): 60-66 |
| [79] | 陈孝平, 汪建平, 赵继宗. 外科学[M]. 第9版, 北京: 人民卫生出版社, 2018, 776 |
| [80] | Jaffe HL, Lichtenstein L. Benign chondroblastoma of bone: A reinterpretation of the so-called calcifying or chondromatous gian cell tumor[J]. The American Journal of Pathology, 1942, 18(6): 969-991 |
| [81] | Hemingway F, Tayler R, Knowles HJ, et al. RANKL-independent human osteoclast formation with APRIL, BAFF, NGF, IGF I and IGF II[J]. Bone, 2011, 48(4): 938-944 |
| [82] | Dahlin DC, Cupps RE, Johnson EW. Giant cell tumors: A study of 195 cases[J]. Cancer, 1970, 25: 1061-1070 |
| [83] | Bertoni F, Bacchini P, Staals EL. Malignancy in giant cell tumor of bone[J]. Cancer, 2003, 97(10): 2520-2529 |
| [84] | Ma YF, Xu W, Yin HB, et al. Therapeutic radiotherapy for gaint cell tumor of the spine: a systemic review[J]. European Spine Journal, 2015, 24(8): 1754-1760 |
| [85] | Takao S. Paleopathological Study on a Case of Osteosarcoma[J]. American Journal of Physical Anthropology, 1987, 74: 309-318 |
| [86] | Alt KW, Adler CP, Buitrago CH, et al. Infant osteosarcoma[J]. International Journal of Osteoarchaeology, 2002, 12: 442-448 |
| [87] | Ortner DJ, Paola P, Alan O, et al. Multicentric osteosarcoma associated with DIsH. in a 19th century burial ffom England[J]. International Journal of Osteoarchaeology, 2012, 22: 245-252 |
| [88] | Odes EJ, Randolph-Quinney PS, Steyn M, et al. Earliest hominin cancer: 1.7-million-yearold osteosarcoma from Swartkrans Cave, South Africa[J]. South African Journal of Science, 2016, 112(7-8): 1-5 |
| [89] | Lavinia FR, Tony W. On the importance of considerig disease subtypes: Earliest detection of a parosteal osteosarcoma? Diferential diagnosis of an osteosarcoma im an Anglo-Saxon female[J]. International Journal of Paleopathology, 2018, 21: 128-137 |
| [90] | Kufterin VV, Dubova NA, Nikiforovsky YA. Tumour-like lesions in a Late Bronze Age skeleton from Gonur Depe, Southern Turkmenistan[J]. International Journal of Osteoarchaeology, 2018, 28: 464-469 |
| [91] | Zhang QC, Zhang Q, Han T, et al. An Iron Age skull with a bone neoplasm from Nilka County, Xinjiang, China[J]. International Journal of Osteoarchaeology, 2019, 29: 1034-1041 |
| [92] | Laffranchi, Marco M, et al. Co-occurrence of malignant neoplasm and Hyperostosis Frontalis Interna in an Iron Age individual from Münsingen-Rain (Switzerland) - A multi-diagnostic study[J]. International Journal of Paleopathology, 2021, 32: 1-8 |
| [93] | You S, Li MC, Hou XG, et al. First case of juvenile primary bone malignant neoplasm in ancient China: A skeleton from the Northern Wei Dynasty (386-534 CE)[J]. International Journal of Osteoarchaeology, 2022, 32: 182-191 |
| [94] | Kate P, Fan WQ, Luo XD. What’s that big thing on your head? Diagnosis of a large frontoparietal lesion on an Eastern Zhou skull from Henan, China[J]. International Journal of Paleopathology, 2019, 26: 84-92 |
| [95] | 韩涛, 张群, 赵惠杰, 等. 宁夏海原石砚子墓地人骨研究[J]. 文博, 2018, 4: 96-104+72 |
| [96] | 张群, 王晓阳, 叶惠媛, 等. 宁夏石砚子墓地颅骨缺损个体的古病理学[J]. 人类学学报, 2020, 39(4): 586-598 |
| [97] | 胥少汀, 葛宝丰, 徐印坎. 实用骨科学[M]. 第4版, 北京: 人民军医出版社, 2012, 1745 |
| [98] | Sandison AT. Letter: Kanam mandible’s tumour[J]. Lancet, 1975, 7901(1): 279 |
| [99] | Monge J, Kricun M, Radov?i? J, et al. Fibrous dysplasia in a 120,000+ year old Neandertal from Krapina, Croatia[J]. PLoS One, 2013, 8(6): e64539 |
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