肱骨近端局灶性纤维软骨发育不良的诊断和治疗  

Diagnosis and treatment for focal fibrocartilaginous dysplasia in proximal humerus

作　　者：周达飞[1] 董轶非[1] 王玉琨[1] 

机构地区：[1]北京积水潭医院小儿骨科,100035

出　　处：《中华小儿外科杂志》2017年第10期778-781,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的通过对肱骨内翻病例的影像及病理学检查，结合术中表现和术后病理结果，验证肱骨近端局灶性纤维软骨发育不良是造成肱骨内翻的确切病因。检验肱骨近端截骨矫形能否改善肩关节功能。方法总结2002年至2015年治疗的12例肱骨内翻畸形，排除感染及外伤等病史，平均年龄12岁，平均随访时间3．8年。肩关节活动外展平均40°-60°，平均53．3°。肩关节前屈上举70°-120°，平均90°。术前行X线，CT及MRI检查。术中切除病变并行肱骨近端楔形截骨矫正畸形。术后对切除病变进行病理检查。结果术前影像学检查均可以观察到典型的局灶性纤维软骨发育不良表现。术后病理6例回报为纤维组织，2例为纤维软骨组织，4例为纤维软骨和纤维组织的混合。12例患儿均应诊断肱骨近端局灶性纤维软骨发育不良。12例患儿术后肩关节外展可达90°。肩关节的前屈上举活动度150°-180°，平均168．3°。手术前后的肩关节功能进行配对t检验，差异有统计学意义（P〈0．005）。术前术后的肢体长度差异无显著性变化。结论无明显病因的肱骨内翻畸形应诊断肱骨近端局灶性纤维软骨发育不良，并依靠典型的影像学表现和病理结果进行确诊。早期诊断并切除病灶有利于恢复上肢长度和肩关节功能。肱骨近端截骨矫形可以明显改善肩关节功能。Objective To review the cases of humeral varus to determine whether or not focal fibrocartilaginous dysplasia （FFCD）is the cause of humeral varus through radiology and pathology and observe whether or not proximal humeral osteotomy improves shoulder functions. Methods A total of 12 cases of humeral varus from 2002 to 2015 were summarized. Patients with history of infection and trauma were excluded. The average age was 12 years old and the mean follow-up period 3.8 years. The average degree of shoulder abduction was 53. 3 degrees and shoulder flexion 90 degrees preoperatively. After preoperative examinations of radiology, computed tomography （CT） and magnetic resonance imaging （MR1）, lesion resection and proximal humeral osteotomy were performed for correcting deformities and pathological examination for resected lesions, Results All cases had typical imaging manifestations. The postoperative pathological examinations demonstrated fibrous cartilage or fibrous tissue. And 12 cases were diagnosed as FFCD in proximal humerus. The average degree of shoulder abduction was 90 degrees and shoulder flexion 168.3 degrees preoperatively. The function of shoulder joint significantly improved. Conclusions The etiology of proximal humeral varus is FFCD, depending on typical manifestations of imaging and pathological examinations. Early diagnosis and resection of lesion may aid the recovery of upper limb length and shoulder function. And proximal humeral osteotomy can significantly improve shoulder functions.

关 键 词：局灶性纤维软骨发育不良 肱骨 诊断 

分 类 号：R726.8[医药卫生—儿科]