儿童关节内/近关节与关节外骨样骨瘤的特点及手术疗效分析  

Characteristics and efficacy analysis of intra-/juxta-articular versus extra-articular osteoid osteoma in childhood

作　　者：方建文 王达辉 郑一鸣 Fang Jianwen;Wang Dahui;Zheng Yiming(Department of Orthopedic,Children's Hospital of Fudan University XiaMen Branch,361000,China;Department of Orthopedic,Children's Hospital of Fudan University,201102,China)

机构地区：[1]复旦大学附属儿科医院厦门分院骨科,福建省厦门市361000 [2]复旦大学附属儿科医院骨科,上海市201102

出　　处：《临床小儿外科杂志》2020年第9期821-824,共4页Journal of Clinical Pediatric Surgery

摘　　要：目的通过对比骨骼未成熟儿童关节内/近关节与关节外骨样骨瘤的临床及影像学特点,探讨儿童关节内/近关节部位骨样骨瘤的临床特点、手术疗效及预后。方法对复旦大学附属儿科医院收治的43例儿童骨样骨瘤病例的临床资料进行分析,其中男31例,女12例,平均年龄8.9岁(1.8~16岁)。根据骨样骨瘤瘤巢部位分成关节内/近关节组(16例)和关节外组(27例),回顾以上病例的临床特点、影像学特点及治疗方法,运用SPSS22.0进行统计学分析。结果关节内/近关节组16例中仅6例存在骨样骨瘤的典型症状,13例存在关节滑膜炎症状,10例误诊,9例存在特征性瘤巢,8例关节周围骨骼出现异常改变;关节内/近关节组平均延迟诊断17个月,与关节外组对比在延迟诊断时间上存在统计学差异(P<0.05)。关节外的骨样骨瘤临床症状和影像学表现更典型,肿瘤受累骨骼存在过度生长现象,但未见跛行等显著临床症状。结论儿童关节内/近关节骨样骨瘤与关节外的骨样骨瘤存在不同的临床表现及影像学特征,同时缺乏典型的骨样骨瘤临床特征,而滑膜炎表现相对较多,跛行或者骨膜反应程度轻,硬化骨不显著,需要与炎症、剥脱性骨软骨炎等鉴别诊断,同时需要更精准的手术治疗。Objective To compare the clinical and radiological features of intra-/juxta-articular osteoid osteoma and extra-articular osteoid osteoma in skeletally immature patients.Discussing about characteristics、efficacy and prognosis of osteoid osteoma in intra-/juxta-articular.Methods Osteoid osteoma in 43 cases,31 boys and 12 girls,mean age at diagnosis was 8.9 years(range 1.8 to 16 years).They were dichotomized according to the loction of the nidus as intra-/juxta-articular(16 children)or extra-articular(27 children)or spine(3 children),review its distribution、clinical features、imaging features and treatment.then data using SPSS22.0 for statistical analysis.Results In this group of 16 cases of intra-/juxta-articular osteoid osteoma,only 6 cases had typical symptoms of osteoid osteoma,13 cases had synovial inflammation of the joint,10 cases had misdiagnosis,9 cases had characteristic nidus,and 8 cases had abnormal changes in bone around joint.indicating that the difference between the above data and the extra-articular group was statistically significant.which lead to an average of 17 months delayed diagnosis in this group.the p-value was less than 0.05,indicating that the difference in delay diagnosis between intra-/juxta-articular and extra-articular group was statistically significant.However,the clinical symptoms and imaging manifestations of extra-articular group were more typical.with excessive growth of tumor affected bones,but no significant clinical symptoms such as claudication.Conclusion Intra-/juxta-articular osteoid osteoma exhibit different clinical and radiological features from extra-articular osteoid osteoma.No typical clinical features,effects of synovitis,limp,an absence or minimal degree of osteosclerosis with subtle periosteal reaction,which is initially assigned to more common differential diagnoses,including inflammatory joint diseases or osteochondritis dissecans.Easy delay diagnosis,need precision surgery.

关 键 词：关节 骨样骨瘤/病理学 骨样骨瘤/外科学 治疗结果 

分 类 号：R726.8[医药卫生—儿科] R738.1[医药卫生—临床医学]