四肢肿瘤及瘤样病变导致病理性骨折的诊断特点  

Diagnostic features of pathological fractures located in extremities caused by bone tumor or tumor- like lesion

作　　者：刘艳成[1] 胡永成[2] 夏群[1] 徐宝山[1] 吉宁[1] 黄洪超[2] 张中礼[3] 

机构地区：[1]天津医院脊柱外科,300211 [2]天津医院骨肿瘤科,300211 [3]天津医院小儿骨科,300211

出　　处：《中华骨科杂志》2011年第9期944-948,共5页Chinese Journal of Orthopaedics

摘　　要：目的探讨四肢肿瘤及瘤样病变导致病理性骨折的诊断特点。方法2002年8月至2010年12月，肿瘤及瘤样病变导致的四肢病理性骨折139例，男79例，女60例；年龄2．4-87．0岁，平均31．3岁。瘤样病变55例，良性肿瘤13例，原发恶性肿瘤28例，转移瘤36例，骨巨细胞瘤7例。分析患者年龄、骨折部位、肿瘤类型、误诊特点，比较不同类型肿瘤的致伤暴力和前驱症状构成差异。结果11-20岁年龄段患者最多（32．4％，45／139）。骨折部位依次为股骨51．1％（71／139）、肱骨25．9％（36／139）、胫骨10．8％（15／139）、指骨5．0％（7／139）、桡骨2．9％（4／139）、尺骨2．2％（3／139）、腓骨1.4％（2／139）、跖骨0．7％（1／139）。骨折的致伤暴力：自发性暴力20．9％（29／139）、功能性暴力30．2％（42／139）、轻微暴力46．8％（65／139）、严重暴力2．2％（3／139）。暴力大小依次为良性肿瘤及瘤样病变、转移瘤、原发恶性肿瘤（Hc=80．980，P=0．000）。前驱症状发生率48．2％（67／139），良性肿瘤及瘤样病变15例（20．0％，15，75），原发恶性肿瘤20例（71．4％，20／28），转移瘤32例（88．9％，32／36）。后两者的差异无统计学意义，均高于良性肿瘤和瘤样病变（X^2=24．037，P=-0．000；X^2=47．283，P=0．000）。20例误诊，误诊率14．4％（20／139）。结论轻微暴力和前驱症状是病理性骨折的常见特征，是避免误诊的关键因素。Objective To explore the clinical characteristics of pathological fracture in extremities caused by bone tumors or tumor-like lesions. Methods From August 2002 to December 2010, 139 patients with pathological fractures were entered in the study, including 79 males and 60 females with an average age of 31.1 years. Fractures included tumor-like lesion in 55 cases, benign tumor in 13, giant cell tumor （GCT） in 7, primary malignant tumors in 28, and metastatic tumors in 36. Forces induced to fractures were classi- fied into four grades： spontaneous fracture, functional activity, minor injury, severe injury. Age, fracture loca- tion, histological results, fractures forces, prodromes, and misdiaguosis were all observed. Chi-square test were use to compare forces and prodromes within different tumors. Results The highest morbidity rate is 32.4% （45/139） which lies in 11-20 years old. The cites of fractures including femurs in 71 cases, humerus in 36, tibia in 15, fingers in 7, radiuses in 4, fibula in 3, ulnas in 2, and metatarsus in 1. Fracture forces include spontaneous fractures in 29 cases, functional activity in 42, minor injuries in 65, and traumatic injuries in 3. Sixty-seven patients （48.2%） had local prodromes. The prodromcs of both malignant tumors and metastatic tumors were more than benign tumors. Twenty cases experienced misdiagnosis with average delay time of 12 weeks. Conclusion Minor injury forces and local prodromes are clinical key features of patho- logical fractures. Both of them are key points of avoiding misdiagnosis.

关 键 词：骨肿瘤 骨折 自发性 诊断 

分 类 号：R739.96[医药卫生—肿瘤]