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目的分析手部掌指骨的动脉瘤样骨囊肿的临床表现,影像学特点,鉴别诊断和治疗方法与复发率的关系。方法回顾2002年至2012年,我院手外科明确诊断的12例手部掌指骨的动脉瘤样骨囊病例的临床症状、体征,X线和MRI的影像学特点,术中大体特征及肿瘤性状表现,手术方法和植骨特点,手术后复发率等。结果 12例中发生部位掌骨8例,指骨4例。年龄和性别无明确特点。临床症状以局部膨胀性改变(10例)和疼痛(6例)为主要特点。X线表现为膨胀性溶骨性病变,晚期可表现为皂泡样和吹气球样骨质破坏。MRI可显示内部大小不一、信号强弱不等的囊腔和病灶内液平面。手术中可见骨皮质呈暗紫色,皮质膨胀变薄。手术采取高速磨钻刮除植骨(4例),段截植骨(8例)等方式。术后复发1例。所有病例均经病理检查最后明确诊断。病理检查发现合并巨细胞瘤1例。结论手部掌指骨动脉瘤样骨囊肿临床罕见,临床表现特异性不强,易与其它肿瘤混淆,早期诊断常面临困难,根据病史特点和x线与MRI结合检查可明显提高诊断准确率,使用高速磨钻彻底刮除和瘤段切除植骨是防止复发的关键。
Objective To analyze the clinical manifestations, imaging characteristics, differential diagnosis and treatment of aneurysmal bone cyst with metacarpal phalanges and the relationship between recurrence rate and recurrence rate. Methods From 2002 to 2012, 12 cases of aneurysmal sacs with palmar phalanges diagnosed by hand surgery in our hospital were retrospectively analyzed. The clinical features, signs, X-ray and MRI features, Performance, surgical methods and bone graft characteristics, postoperative recurrence rate. Results Occipital metacarpal bone in 8 cases and phalange in 4 cases. Age and gender have no specific characteristics. Clinical symptoms with local dilative changes (10 cases) and pain (6 cases) as the main feature. X-ray showed expansive osteolytic lesions, late-stage can be expressed as soap bubbles and inflatable balloon-like bone destruction. MRI can show the internal size, signal strength ranging from cysts and lesions within the fluid level. Visible cortical dark purple surgery, cortical expansion thinning. Surgery to take high-speed drill scraping bone grafting (4 cases), section of bone graft (8 cases) and other means. Recurrence after surgery in 1 case. All cases were confirmed by the final pathological examination. One case of giant cell tumor was found by pathological examination. Conclusions Hand palm phalanges aneurysmal bone cysts are rare clinical manifestations of specificity is not strong, easily confused with other tumors, early diagnosis often face difficulties, according to medical history and X-ray examination combined with MRI can significantly improve the diagnostic accuracy, the use of Thoroughly curettage and tumor resection and bone graft is the key to prevent recurrence.