腕钩骨动脉瘤样骨囊肿一例报告及文献复习  

Aneurysmal bone cyst of the wrist hamate:a case report and literature review

作　　者：吴学强[1] 刘会仁[1] 刘建华[1] Wu Xueqiang;Liu Huiren;Liu Jianhua(Department of Hand Surgery,Tangshan Second Hospital,Tangshan 063000,China)

机构地区：[1]唐山市第二医院手外科,唐山063000

出　　处：《中华骨科杂志》2024年第1期48-52,共5页Chinese Journal of Orthopaedics

摘　　要：报告1例腕钩骨动脉瘤样骨囊肿(Aneurysmal bone cyst,ABC),男,30岁。体格检查:右腕尺背侧有直径约1.5 cm的隆起包块,局部无红肿,压痛明显;肿物触之质硬,局部皮温不高,无异常活动及骨擦感。右腕关节屈曲正常,背伸70°。右腕关节正位X线片示钩骨变形,中心大面积囊变,仅存薄层软骨下骨。CT冠状面重建示右腕钩骨边界清楚的溶骨性改变,其内可见骨嵴。冠状面MRI示右腕钩骨T1WI、T2WI呈混杂信号。入院诊断为右腕钩骨肿物。手术活检可见钩骨背侧皮质变薄,呈深蓝色;骨皮质质软,用手术刀可轻易划开。开窗后可见钩骨内充满暗红色软组织及血液,骨质破坏,残存部分游离松质骨块。组织病理学报告为动脉瘤样骨囊肿。二期手术行右腕钩骨摘除,取髂骨植骨于原钩骨位置,克氏针固定;予头钩关节及第4、5腕掌关节融合。术后石膏固定6周。随访15个月,无复发。既往文献中涉及腕骨ABC很少,均为个案报告。腕部ABC主要发生在年轻人群,超过75%的病例发病年龄低于30岁。主要表现为腕关节疼痛,部分病例伴有局部轻度肿胀,腕关节活动受限以及患侧手握力减弱。X线片、CT及MRI表现为膨胀性溶骨性改变。MRI T1WI呈低信号,T2WI呈高信号,横断面可见液平面。腕骨ABC的治疗方法主要为腕骨摘除术和病灶内刮除植骨术。破骨样多核巨细胞、骨化区和被纤维间隔分隔的囊腔是诊断ABC的标志性表现。腕骨ABC的预后较好。A rare instance of an aneurysmal bone cyst(ABC)in the wrist hamate of a 30-year-old male were reported in this case report.The patient exhibited a 1.5 cm mass on the dorsal ulnar side of the right wrist,which was non-tender,with normal overlying skin temperature and preserved wrist flexion.Radiographic evaluation revealed a deformed hamate with extensive cystic degeneration and minimal subchondral bone.Computed tomography(CT)scans highlighted clear osteolytic changes,including a visible bony crest.Magnetic resonance imaging(MRI)depicted mixed signal intensity on T1 and T2 weighted images.A biopsy indicated thinning and softening of the hamate's dorsal cortex,revealing eroded bone and dark red soft tissue.Histopathological analysis confirmed the diagnosis of an aneurysmal bone cyst.The patient underwent resection of the right wrist hamate,bone grafting from the iliac crest,and stabilization with Kirschner wire,resulting in fusion of the capitate-hamate and fourth and fifth carpometacarpal joints.The postoperative course involved immobilization with plaster for six weeks,and a 15-month follow-up indicated no recurrence.A review of the literature revealed that ABCs involving carpal bones are rare,predominantly occurring in individuals under 30 years of age.Clinical manifestations typically include wrist pain,occasional mild swelling,limited wrist mobility,and reduced hand strength.Radiological findings are characterized by osteolytic changes with MRI showing low T1WI and high T2WI signal intensity,and liquid levels on axial images.Treatment predominantly involves osteotomy or curettage with bone grafting.Diagnostic hallmarks include osteoclast-like multinucleated giant cells,ossified areas,and cystic cavities partitioned by fibrous septa.Our findings,consistent with the literature,suggest a favorable prognosis for carpal bone ABCs when treated appropriately.

关 键 词：腕骨 钩骨 骨囊肿 动脉瘤样 病例报告 

分 类 号：R687.3[医药卫生—骨科学]