23例髋部骨样骨瘤的临床特征及误诊原因分析
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摘要
背景:骨样骨瘤为临床常见的良性骨肿瘤,发生在关节内的骨样骨瘤,由于临床症状不典型,容易造成误诊漏诊,尤其是髋部骨样骨瘤,由于并发症较多,容易与其他髋部疾病相混淆,临床误诊率较高。目的:探讨髋部骨样骨瘤的临床特征及误诊原因,为准确诊疗髋部骨样骨瘤提供临床思路。方法:回顾性分析2010年6月至2017年10月收治的髋部骨样骨瘤患者23例,男21例,女2例;年龄为5～30岁,平均(14.9±7.9)岁。术前收集患者外院的诊疗资料,完善X线片及CT检查。对比手术前后视觉模拟评分(VAS)疼痛评分及改良髋关节Harris评分评估手术疗效。结果:22例曾被误诊,误诊为滑膜炎9次,股骨头坏死4次,骨髓炎、关节内感染、类风湿性关节炎、强直性脊柱炎各3次,髋关节发育不良、腰椎间盘突出症、关节结核、幼年特发性关节炎各2次,扁平髋、股骨头囊肿、骨梗死、色素沉着绒毛结节性滑膜炎各1次。从发病到确诊需4d～36个月不等,确诊时间平均为(11.3±8.0)个月。11例出现股骨颈增粗,8例出现股骨头肥大,13例出现骨盆倾斜,5例出现膝部放射痛。16例X线片可见瘤巢,23例CT检查示瘤巢。全部患者均获得随访,随访时间为8～88个月,平均随访时间(49.2±24.4)个月,患者VAS疼痛评分由术前的(7.0±0.9)分降到术后48 h的(1.9±1.3)分,疼痛较术前明显缓解(P<0.01);末次随访时患者改良髋关节Harris评分(96.3±2.2)分,较术前(65.1±17.2)分明显提高(P<0.01),关节功能优良率达100.0%。结论:对髋部骨样骨瘤认识不够、选择错误的检查方法以及该病临床表现复杂多样是导致误诊的主要原因,薄层CT能够准确诊断及定位髋部骨样骨瘤。
Background: Osteoid osteoma(OO) is an osteoblastic benign bone lesion that may be easily diagnosed when the typical clinical and radiological features are present. However, due to the atypical symptom, intra-articular osteoid osteoma(IAOO) may occasionally be difficult to diagnose accurately. Especially in the hip, due to various complications, the hip osteoid osteoma(HOO) is easy to be confused with other hip diseases, resulting in a high rate of clinical misdiagnosis. Objective:To investigate the clinical features and misdiagnosis reasons of the hip osteoid osteoma so that to provide an accurate diagnostic and therapeutic strategy. Methods: From June 2010 to October 2017, 23 patients with hip osteoid osteoma were retrospectively reviewed, including 21 males and 2 females with the age ranging from 5 to 30 years and the average of(14.9±7.9) years old. Clinical materials were collected for all the patients including that of other hospitals and X-ray plain radiograph and CT scan were required before the operation. VAS score and the modified Harris hip score before and after the operation were recorded and compared to evaluate the effect of the operation. Results: 22 patients had been misdiagnosed as synovitis for 9 times, osteonecrosis of femur head for 4 times, osteomyelitis for 3 times, intra-articular infection for 3 times, rheumatoid arthritis for 3 times,ankylosing spondylitis for 3 times, developmental dysplasia of hip for 2 times, lumbar disc herniation for 2 times,osteoarticular tuberculosis for 2 times,juvenile idiopathic arthritis for 2 times, coxa plana once, cyst of femur head once, bone infarction once, and pigmented villonodular synovitis once. The average time of diagnosis confirmation was(11.3±8.0) months ranging from 4 days to 36 months. 11 patients had the femoral neck widened, 8 patients had hypertrophy of the femoral head,13 patients had inclination of pelvis, 5 patients had radiating knee pain. Nidus was found in 16 patients by plain radiographs while all patients had nidus shown by CT scan. All patients were followed up for 8-88 months with an average time of(49.2±24.4) months. The VAS score decreased significantly from preoperative(7.0±0.9) to(1.9±1.3) at 24 hours after the operation(P<0.01). The modified hip joint Harris score was(96.3±2.2) at the last follow-up which was significantly higher than that(65.1±17.2) before the operation(P<0.01). Conclusions: The main causes resulting in misdiagnosis are the lack of the related knowledge about osteoid osteoma, selection of inappropriate auxiliary examinations and the confusing clinical manifestations.HOO can be diagnosed and located precisely by thin-section CT scan.
Background: Osteoid osteoma(OO) is an osteoblastic benign bone lesion that may be easily diagnosed when the typical clinical and radiological features are present. However, due to the atypical symptom, intra-articular osteoid osteoma(IAOO) may occasionally be difficult to diagnose accurately. Especially in the hip, due to various complications, the hip osteoid osteoma(HOO) is easy to be confused with other hip diseases, resulting in a high rate of clinical misdiagnosis. Objective:To investigate the clinical features and misdiagnosis reasons of the hip osteoid osteoma so that to provide an accurate diagnostic and therapeutic strategy. Methods: From June 2010 to October 2017, 23 patients with hip osteoid osteoma were retrospectively reviewed, including 21 males and 2 females with the age ranging from 5 to 30 years and the average of(14.9±7.9) years old. Clinical materials were collected for all the patients including that of other hospitals and X-ray plain radiograph and CT scan were required before the operation. VAS score and the modified Harris hip score before and after the operation were recorded and compared to evaluate the effect of the operation. Results: 22 patients had been misdiagnosed as synovitis for 9 times, osteonecrosis of femur head for 4 times, osteomyelitis for 3 times, intra-articular infection for 3 times, rheumatoid arthritis for 3 times,ankylosing spondylitis for 3 times, developmental dysplasia of hip for 2 times, lumbar disc herniation for 2 times,osteoarticular tuberculosis for 2 times,juvenile idiopathic arthritis for 2 times, coxa plana once, cyst of femur head once, bone infarction once, and pigmented villonodular synovitis once. The average time of diagnosis confirmation was(11.3±8.0) months ranging from 4 days to 36 months. 11 patients had the femoral neck widened, 8 patients had hypertrophy of the femoral head,13 patients had inclination of pelvis, 5 patients had radiating knee pain. Nidus was found in 16 patients by plain radiographs while all patients had nidus shown by CT scan. All patients were followed up for 8-88 months with an average time of(49.2±24.4) months. The VAS score decreased significantly from preoperative(7.0±0.9) to(1.9±1.3) at 24 hours after the operation(P<0.01). The modified hip joint Harris score was(96.3±2.2) at the last follow-up which was significantly higher than that(65.1±17.2) before the operation(P<0.01). Conclusions: The main causes resulting in misdiagnosis are the lack of the related knowledge about osteoid osteoma, selection of inappropriate auxiliary examinations and the confusing clinical manifestations.HOO can be diagnosed and located precisely by thin-section CT scan.
引文
[1]Jaffe HL.“Osteoid-osteoma”:a benign osteoblastic tumor composed of osteoid and atypical bone.Arch Surg,1935,31(5):709-728.
[2]Orth P,Kohn D.Diagnostics and treatment of osteoid osteoma.Orthopade,2017,46(6):1-12.
[3]张小军,王臻,李靖.3409例骨关节肿瘤与瘤样病变统计分析.中国骨与关节杂志,2010,9(3):189-195.
[4]Allen SD,Saifuddin A.Imaging of intra-articular osteoid osteoma.Clin Radiol,2003,58(11):845-852.
[5]Rimondi E,Mavrogenis AF,Rossi G,et al.Radiofrequency ablation for non-spinal osteoid osteomas in 557 patients.Eur Radiol,2012,22(1):181-188.
[6]Rolvien T,Zustin J,Mussawy H,et al.Intra-articular osteoid osteoma as a differential diagnosis of diffuse mono-articular joint pain.BMC Musculoskelet Disord,2016,17(1):455.
[7]Davies M,Cassar-Pullicino VN,Davies AM,et al.The diagnostic accuracy of MR imaging in osteoid osteoma.Skeletal Radiol,2002,31(10):559-569.
[8]肖林,胡剑波,吴泽文,等.30例影像学表现类似骨样骨瘤病变的鉴别诊断.肿瘤基础与临床,2015,28(1):56-58.
[9]Scalici J,Jacquel A,Mukish P,et al.Intra-articular osteoid osteoma of the hip misdiagnosed by MRI:An unusual cause of unexplained hip pain.Orthop Traumatol Surg Res,2011,97(8):881-885.
[10]赵旻,韦峰,姜亮,等.非甾体抗炎药物治疗成人枢椎骨样骨瘤1例报告.中国脊柱脊髓杂志,2016,26(6):571-573.
[11]Richardson MD,Taylor J.Intra-articular osteoid osteoma in the femoral neck of an 18-year-old man:a case report.JManipulative Physiol Ther,2009,32(3):245-250.
[12]Sferopoulos NK.Subtrochanteric osteoid osteoma:A misdiagnosed case complicated by a hip fracture.Chin J Traumatol,2016,19(5):283-285.
[13]Song M,Yoo W,Cho TJ,et al.Clinical and radiological features and skeletal sequelae in childhood intra-/juxta-articular versus extra-articular osteoid osteoma.BMC Musculoskelet Disord,2015,16(1):1-6.
[14]Banga K,Racano A,Ayeni OR,et al.Atypical hip pain:of femoroacetabular impingement(FAI)and osteoid osteoma.Knee Surg Sports Traumatol Arthroscy,2015,23(5):1571-1574.
[15]Cassar-Pullicino VN,Mccall IW,Wan S.Intra-articular osteoid osteoma.Clin Radiol,1992,45(3):153-160.
[16]Xiao J,Lam SK,Shi Z,et al.Osteoid osteoma of the femoral neck causes deformity in children:a case report.Hip Int,2011,21(4):490-494.
[17]Pianta M,Crowther S,Mcnally D,et al.Proximal femoral intracapsular osteoid osteoma in a 16-year-old male with epiphyseal periostitis contributing to Cam-type deformity relating to femoro-acetabular impingement.Skeletal Radiology,2013,42(1):129-133.
[18]Mungo DV,Zhang X,O'Keefe RJ,et al.COX-1 and COX-2 expression in osteoid osteomas.J Orthop Res,2002,20(1):159-162.
[19]Hasegawa T,Hirose T,Sakamoto R,et al.Mechanism of pain in osteoid osteomas:an immunohistochemical study.Histopathology,1993,22(5):487-491.
[20]Conconi MT,Tommasini M,Baiguera S,et al.Effects of prostaglandins E1 and E2 on the growth and differentiation of osteoblast-like cells cultured in vitro.Int J Mol Med,2002,10(4):451-456.
[21]Abboud S,Kosmas C,Novak R,et al.Long-term clinical outcomes of dual-cycle radiofrequency ablation technique for treatment of osteoid osteoma.Skeletal Radiol,2016,45(5):599-606.
[22]Coupal TM,Mallinson PI,Munk PL,et al.CT-guided percutaneous cryoablation for osteoid osteoma:initial experience in adults.AJR Am J Roentgenol,2014,202(5):1136-1139..
[23]Raux S,Abelin-Genevois K,Canterino I,et al.Osteoid osteoma of the proximal femur:treatment by percutaneous bone resection and drilling(PBRD).A report of 44 cases.Orthop Traumatol Surg Res,2014,100(6):641-645.
[24]郭晓柠,李晓阳,黎志宏,等.开放切除手术治疗股骨小转子部骨样骨瘤的疗效分析.中南大学学报(医学版),2016,41(12):1291-1296.
[2]Orth P,Kohn D.Diagnostics and treatment of osteoid osteoma.Orthopade,2017,46(6):1-12.
[3]张小军,王臻,李靖.3409例骨关节肿瘤与瘤样病变统计分析.中国骨与关节杂志,2010,9(3):189-195.
[4]Allen SD,Saifuddin A.Imaging of intra-articular osteoid osteoma.Clin Radiol,2003,58(11):845-852.
[5]Rimondi E,Mavrogenis AF,Rossi G,et al.Radiofrequency ablation for non-spinal osteoid osteomas in 557 patients.Eur Radiol,2012,22(1):181-188.
[6]Rolvien T,Zustin J,Mussawy H,et al.Intra-articular osteoid osteoma as a differential diagnosis of diffuse mono-articular joint pain.BMC Musculoskelet Disord,2016,17(1):455.
[7]Davies M,Cassar-Pullicino VN,Davies AM,et al.The diagnostic accuracy of MR imaging in osteoid osteoma.Skeletal Radiol,2002,31(10):559-569.
[8]肖林,胡剑波,吴泽文,等.30例影像学表现类似骨样骨瘤病变的鉴别诊断.肿瘤基础与临床,2015,28(1):56-58.
[9]Scalici J,Jacquel A,Mukish P,et al.Intra-articular osteoid osteoma of the hip misdiagnosed by MRI:An unusual cause of unexplained hip pain.Orthop Traumatol Surg Res,2011,97(8):881-885.
[10]赵旻,韦峰,姜亮,等.非甾体抗炎药物治疗成人枢椎骨样骨瘤1例报告.中国脊柱脊髓杂志,2016,26(6):571-573.
[11]Richardson MD,Taylor J.Intra-articular osteoid osteoma in the femoral neck of an 18-year-old man:a case report.JManipulative Physiol Ther,2009,32(3):245-250.
[12]Sferopoulos NK.Subtrochanteric osteoid osteoma:A misdiagnosed case complicated by a hip fracture.Chin J Traumatol,2016,19(5):283-285.
[13]Song M,Yoo W,Cho TJ,et al.Clinical and radiological features and skeletal sequelae in childhood intra-/juxta-articular versus extra-articular osteoid osteoma.BMC Musculoskelet Disord,2015,16(1):1-6.
[14]Banga K,Racano A,Ayeni OR,et al.Atypical hip pain:of femoroacetabular impingement(FAI)and osteoid osteoma.Knee Surg Sports Traumatol Arthroscy,2015,23(5):1571-1574.
[15]Cassar-Pullicino VN,Mccall IW,Wan S.Intra-articular osteoid osteoma.Clin Radiol,1992,45(3):153-160.
[16]Xiao J,Lam SK,Shi Z,et al.Osteoid osteoma of the femoral neck causes deformity in children:a case report.Hip Int,2011,21(4):490-494.
[17]Pianta M,Crowther S,Mcnally D,et al.Proximal femoral intracapsular osteoid osteoma in a 16-year-old male with epiphyseal periostitis contributing to Cam-type deformity relating to femoro-acetabular impingement.Skeletal Radiology,2013,42(1):129-133.
[18]Mungo DV,Zhang X,O'Keefe RJ,et al.COX-1 and COX-2 expression in osteoid osteomas.J Orthop Res,2002,20(1):159-162.
[19]Hasegawa T,Hirose T,Sakamoto R,et al.Mechanism of pain in osteoid osteomas:an immunohistochemical study.Histopathology,1993,22(5):487-491.
[20]Conconi MT,Tommasini M,Baiguera S,et al.Effects of prostaglandins E1 and E2 on the growth and differentiation of osteoblast-like cells cultured in vitro.Int J Mol Med,2002,10(4):451-456.
[21]Abboud S,Kosmas C,Novak R,et al.Long-term clinical outcomes of dual-cycle radiofrequency ablation technique for treatment of osteoid osteoma.Skeletal Radiol,2016,45(5):599-606.
[22]Coupal TM,Mallinson PI,Munk PL,et al.CT-guided percutaneous cryoablation for osteoid osteoma:initial experience in adults.AJR Am J Roentgenol,2014,202(5):1136-1139..
[23]Raux S,Abelin-Genevois K,Canterino I,et al.Osteoid osteoma of the proximal femur:treatment by percutaneous bone resection and drilling(PBRD).A report of 44 cases.Orthop Traumatol Surg Res,2014,100(6):641-645.
[24]郭晓柠,李晓阳,黎志宏,等.开放切除手术治疗股骨小转子部骨样骨瘤的疗效分析.中南大学学报(医学版),2016,41(12):1291-1296.