骨巨细胞瘤八例误诊原因分析  

Analysis on Causes of Misdiagnosis in 8 Cases with Giant Cell Tumor of Bone

作　　者：董攀 许元智 尹帅 李金彪 DONG Pan;XU Yuan-zhi;YIN Shuai;LI Jin-biao(Department of Orthopedics,the Heping Hospital of Cangzhou City,Cangzhou,Hebei 061000,China;Department of Orthopedics,Cangxian Hospital,Cangxian,Hebei 061000,China;Department of Orthopedics,the Integrated Chinese and Western Medicine of Hebei Cangzhou Hospital,Cangzhou,Hebei 061000,China)

机构地区：[1]沧州和平医院骨科,河北沧州061000 [2]沧县医院骨科,河北沧县061000 [3]河北省沧州中西医结合医院骨科,河北沧州061000

出　　处：《临床误诊误治》2021年第1期22-25,共4页Clinical Misdiagnosis & Mistherapy

基　　金：河北省中医药管理局科研计划项目(2018514)。

摘　　要：目的探讨骨巨细胞瘤(giant cell tumor of bone,GCT)的临床特点、误诊原因及防范措施,以提高GCT的临床诊治水平。方法对术前曾误诊的8例GCT的临床和影像学资料进行回顾性分析。结果本组8例中因右侧髋部疼痛,行走困难入院2例;因左侧和右侧胫骨上段疼痛入院2例;因背部疼痛,且疼痛向右胸肋放射,夜间加重入院2例;因胸前肿物逐渐增大伴疼痛入院1例,因右膝关节不适和疼痛入院1例。误诊为骨囊肿、非骨化性纤维瘤和肋间神经痛各2例,胸锁关节结核和软骨母细胞瘤各1例。误诊时间2~9(8.02±0.14)d。8例均行手术治疗,术后病理检查皆证实为GCT,均病情好转后出院。随访1年,8例均未复发。结论GCT临床表现及影像学特征缺乏特异性,易致误诊。临床医生应加强对其认识,仔细问诊及查体,并要拓宽诊断思维,遇及类似本文临床表现不典型的GCT患者要进一步完善CT和MRI检查,以减少或避免GCT误诊误治。Objective To investigate the clinical characteristics,causes of misdianosis and preventive measures of giant cell tumor of bone(GCT)to improve the level of clinical diagnosis and treatment of GCT.Methods The clinical and imaging data of 8 cases with GCT misdiagnosed before surgery were retrospectively analyzed.Results Among the 8 misdiagnosed cases in this group,2 patients were admitted to the hospital due to pain in the right hip and difficulty in walking.2 patients admitted for left and right upper tibial pain,2 patients hospitalized due to back pain,which radiated to the right sternum and worsened at night,1 patient admitted due to gradual enlargement of the chest mass and pain,and 1 case for discomfort in the right knee joint and pain.Among these patients,2 cases were misdiagnosed as bone cysts,2 cases as non-ossifying fibroma,2 cases as intercostal neuralgia,1 case as sternoclavicular tuberculosis and 1 case as chondroblastoma.The duration of misdiagnosis was 2-9(8.02±0.14)days.All 8 cases were confirmed as GCT by pathology after surgery,and discharged after the condition was improved.There was no recurrence after discharge at 1-year follow-up.Conclusion The clinical manifestations and imaging characteristics of GCT are not typical,therefore,misdiagnosis is more likely to occur.Clinicians need to strengthen their understanding,make careful consultations and physical examinations,and expand their diagnostic thinking.For atypical patients,clinicians need to further improve CT and MRI examinations,so as to reduce or avoid GCT misdiagnosis.

关 键 词：骨巨细胞瘤 误诊 骨囊肿 纤维瘤 肋间神经痛 结核 骨关节 软骨母细胞瘤 

分 类 号：R730.262[医药卫生—肿瘤]