儿童股骨近端骨病变的病种分布及影像学表现探讨  

Disease distributions and imaging features of proximal femoral bone lesions in children

作　　者：高志鹏 林刚 鞠黎 Gao Zhipeng;Lin Gang;Ju Li(Department of Orthopedics,Affiliated Children's Hospital,Nanjing Medical University,Nanjing 210000,China;Department of Orthopedics,Affiliated Changzhou Children's Hospital,Nantong University,Changzhou)

机构地区：[1]南京医科大学附属儿童医院骨科,南京210000 [2]南通大学附属常州市儿童医院骨科,常州213003

出　　处：《临床小儿外科杂志》2022年第4期374-379,共6页Journal of Clinical Pediatric Surgery

摘　　要：目的探讨儿童股骨近端骨病变的病种分布、临床表现及影像学特征,以提高儿童股骨近端骨病变的临床诊断水平。方法回顾性收集南京医科大学附属儿童医院骨科于2012年2月至2020年5月期间经手术及病理学检查证实的82例股骨近端骨病变患儿临床资料,对其病种分布、临床表现及影像学特征进行分析。结果82例患儿中,男童55例,女童27例;年龄(7.8±3.5)岁(1个月17天至13岁9个月)。病变部位:左侧39例,右侧43例。首发症状为髋部疼痛31例,下肢跛行24例,下肢拒动3例,髋部疼痛伴发热2例,双下肢粗细不等1例,无痛性包块1例,20例为外伤后摄片发现。影像学表现均为股骨近端不同形态骨病变。病理诊断:单纯性骨囊肿30例,纤维结构不良20例,慢性骨髓炎11例,骨样骨瘤7例,朗格汉斯细胞组织细胞增生症5例,软骨母细胞瘤3例,非骨化性纤维瘤2例,骨软骨瘤2例,内生软骨瘤1例,骨卡波西型血管内皮细胞瘤1例。结论儿童股骨近端骨病变临床表现缺乏特异性,病种较多,良性骨病变占比较大,其中以囊性病变居多。儿童出现不明原因髋部疼痛或下肢跛行,应及时拍摄骨盆DR,必要时行CT及MRI检查,以帮助诊断;病理检查是明确诊断的最终手段。Objective To explore the disease distributions,clinical manifestations and imaging features of proximal femoral bone lesions in children.Methods From February 2012 to May 2020,a total of 82 pathologically confirmed children with proximal femoral bone lesions were reviewed retrospectively.Disease distributions,clinical manifestations and imaging features were analyzed.Results There were 55 boys and 27 girls with an average treatment age of(7.8±3.5)(47 days to 165 months).The lesion was on the left side in 39 cases and on the right side in 43 cases.Chief complaints included hip pain(n=31),limping(n=24),post-traumatic radiographic findings(n=20),hip pain with fever(n=2),refusal of moving lower limbs(n=3),unequal circumferential diameters of both lower limbs(n=1)and painless mass(n=1).Simple bone cyst(n=30),fibrous dysplasia(n=20),chronic osteomyelitis(n=11),osteoidosteoma(n=7),Langerhans cell histiocytosis(n=5),chondroblastoma(n=3),non-ossifying fibroma(n=2),osteochondroma(n=2),enchondroma(n=1)and Kaposiform hemangioendothelioma(n=1)were pathologically diagnosed.Conclusion It is difficult to make a definite early diagnosis of proximal femoral bone lesions in children.Great varieties of proximal femoral bone lesions exist in children are different from those in adults.Benign and cystic bone lesions are majority.The clinical manifestations generally lack specificity.For unexplained hip pain or limping in children,the pelvic radiography should be performed immediately and the CT/MRI scan are required for a precise diagnosis if necessary,and the pathological examination is essential for making a definite diagnosis.

关 键 词：股骨/病理学 放射摄影影像解释 计算机辅助 

分 类 号：R726.8[医药卫生—儿科]