手部骨肿瘤及瘤样病变

作者对１９０例手部骨肿瘤及瘤样病变从临床，Ｘ线及病理上进行了回顾性分析．其中良性肿瘤明显多于恶性肿瘤，其比例为２５．４：１．以软骨瘤最多见（７６．３％），骨软骨瘤次之（１１．６％）．恶性肿瘤少见，以转移瘤和软骨肉瘤较多见．各种肿瘤的分布部位似有特点，软骨性肿瘤以近节指骨多见，掌骨次之．骨巨细胞瘤以掌骨多见．转移瘤以末节指骨多见．病理诊断是最可靠的方法，但在确诊时必须结合临床及Ｘ线表现．     

带滑膜腓骨近端移植重建腕关节四例报告

自１９８８年以来，我们对４例桡骨远端巨细胞瘤，采用桡骨远段切除，带滑膜游离腓骨近端移植重建桡骨缺损的手术方式，腕关节功能恢复满意。典型病例 患者，男２７岁。因右前臂远端肿痛１年，于 １９９３年１０月２８日入院。查体：右前臂远端肿胀，腕关节尺偏畸形，腕桡侧膨隆，局部皮肤温度增高，压痛明显，关节屈伸活动受限。ｘ线片显示：右桡骨远端有４．５ｃｍＸ３．０ｃｍ膨胀性泡沫样改变，桡骨远端背侧骨皮质破坏，无骨膜反应，周围软组织肿胀。诊断：右桡骨远端骨巨细胞瘤。术中见桡骨远端骨皮质膨胀性破坏，桡腕关节软骨面完…     

脊柱骨巨细胞瘤的CT与MRI诊断

目的探讨脊柱骨巨细胞瘤的CT、MRI表现及其诊断价值。方法本组17例为经手术病理证实的脊柱巨细胞瘤患者，男13例，女4例，平均年龄49岁；临床与影像学资料齐全。分析病灶的影像学特征及其对诊断与鉴别诊断意义。结果17例脊柱巨细胞肿瘤患者中颈椎5例，胸椎7例，腰椎2例，骶椎3例；14例仅累及1个椎体，3，例累及2个椎体。本组患者X线片示：11例表现为椎体溶骨性破坏并具一定的膨胀性，6例表现为椎体不同程度的压缩。CT示：椎体破坏区无骨性成分存留。MRI示：T1 WI为较均匀中至低信号，T2 WI为较均匀高信号，病灶部分呈良性的硬化骨边缘，部分终板破坏形成软组织肿块。结论脊柱巨细胞瘤影像学表现不同于四肢巨细胞瘤，瘤内无孵确骨性成分存留；可分为膨胀型和压缩型，兼有良、恶性肿瘤的影像学特征，主要应与脊柱动脉瘤样骨囊肿及转移瘤相鉴别。     

手部伴骨破坏的腱鞘巨细胞瘤

目的了解有骨破坏和无骨破坏腱鞘巨细胞瘤与肿瘤复发的关系。方法回顾分析1980年1月至2003年3月期间在我院住院治疗的手部腱鞘巨细胞瘤，共98份完整病史和长期随访结果，根据肿瘤侵犯骨皮质的程度进行分组，用流式细胞分析法对其细胞的增殖活性进行分析。结果98例中骨正常组55例，骨腐蚀组16例，骨破坏组27例。骨正常组术后肿瘤复发率为30.9％；骨腐蚀组为31．3％；骨破坏组为29．6％，三组之间的差异无显著性意义(X^2=0．18，P=0．99)。骨破坏组术后手部并发症发生率为48．1％，骨正常组为18．2％，骨腐蚀组为31．3％，三组问差异有显著性意义(X^2=8．03，P=0．018)。流式细胞分析结果显示，三组间S期细胞百分比差异无显著性意义(F=0．328，P=0．721)。结论伴骨破坏的腱鞘巨细胞瘤临床并非少见，其细胞增殖活性与无骨破坏的腱鞘巨细胞瘤相当，术后肿瘤容易复发的原因，可能是手术切除不彻底。术后并发症的发生率较不伴骨破坏的腱鞘巨细胞瘤明显增高。     

脊柱浆细胞瘤的CT表现特征及鉴别诊断

目的探讨脊柱浆细胞瘤的CT特征及鉴别诊断。方法回顾性分析12例经手术病理证实的脊柱浆细胞瘤患者。均摄X线脊柱平片和CT扫描。影像学重点分析肿瘤形态学、病灶密度、发生部位、椎管和软组织的变化。结果12例中有5例发生于颈椎，4例发生于胸椎，1例发生于腰椎，2例发生于骶椎。5例病变位于椎体，3例位于脊柱附件，4例同时累及椎体和附件。CT表现为椎体内线状骨小梁残留和终板皱褶样的骨破坏，肿瘤均匀强化。椎体不完全破坏5例，椎体完全破坏4例，椎体塌陷3例。结论脊柱浆细胞瘤单发多见，位于颈、胸椎为主，CT表现为瘤体内线状骨小梁残存和终板呈皱褶样改变。鉴别诊断包括单发血管瘤，转移瘤和巨细胞瘤。     

手部腱鞘巨细胞瘤复发原因分析

目的探讨手部腱鞘巨细胞瘤的好发部位，以及临床上出现骨皮质侵蚀，受累关节退行性改变与肿瘤复发的关系。方法回顾分析1993～2003年间32例手部腱鞘巨细胞瘤入院患者的病史、体格检查、影像学检查，所有病例均行手术治疗，并就其性别、年龄、肿瘤生长部位及出现骨皮质侵蚀，受累关节退行性改变进行分析。结果该肿瘤好发于青壮年女性，左手好发，好发部位为拇指和中指。复发病例中常见骨皮质侵蚀和关节融合的退行性改变。结论局部瘤体切除是治疗腱鞘巨细胞瘤的最佳治疗方案，对多次复发有恶变倾向者应行根治性手术。     

手术治疗骨巨细胞瘤54例远期疗效分析

手术治疗骨巨细胞瘤５４例远期疗效分析陈孔冠林深镇郑钦洪⒇我们从１９８２年以来共收治不同部位的病理分级为Ⅰ～Ⅱ级的骨巨细胞瘤５４例，全部采用该方法治疗，术后随访２～１４年，疗效满意，优良率达９４．４％，现报告如下：１临床资料全部病例均经Ｘ线检查及病理确...     

肺癌食指骨转移1例

肺癌食指骨转移１例肖穗春，杜就学，陈伟光，何志成，陈耀新病人男，５９岁。因左食指末节肿胀２０天，Ｘ线拍片示左食指末节指骨有溶骨性破坏，Ｘ线胸片及ＣＴ发现左上肺原发性外围型肺癌。查体见左食指末节鼓杵状肿大，约３．４ｃｍ×２．４ｃｍ×２．４ｃｍ，无潮红及...     

几丁糖阿霉素缓释药粒治疗骨巨细胞瘤的临床初步观察

为了观察骨巨细胞瘤刮除术后局部应用几丁糖阿霉素缓释药粒的疗效及全身反应，对４例骨巨细胞瘤刮除术后残腔应用４倍于常规静脉阿霉素用量的几丁糖阿霉素缓释药粒，检测术后１，２及５天血浆中阿霉素含量，以及术后１周、１个月及６个月的肝肾功能。结果表明，术后１，２及５天血浆中阿霉素含量分别为（１４３．０５±２７．５５）ｎｇ／ｍｌ、（５２．１７±１１．２８）ｎｇ／ｍｌ及（４．２５±３．０７）ｎｇ／ｍｌ，术后１周、１个月及６个月的肝肾功能均正常。随访７个月～１９个月，无局部复发、全身反应及Ｘ线片复发表现。认为，几丁糖阿霉素缓释药粒用于骨巨细胞瘤刮除术后是安全、有效的。     

手部恶性腱鞘巨细胞瘤二例

手部恶性腱鞘巨细胞瘤二例路奎元，黄公怡，王福权，骆燕禧，刘长贵，马正中恶性腱鞘巨细胞瘤非常少见，我们最近诊治２例手部恶性腱鞘巨细胞瘤，现报告如下。例１５９岁，女性。左中指背部肿物１年。肿物呈圆形，约１ｃｍ×１ｃｍ大小，边界清楚．诊断为腱鞘囊肿而行手术...     

Tenosynovial Giant Cell Tumor in the Midfoot Treated With Femoral Head Allograft Reconstruction

Tenosynovial giant cell tumor (also known as giant cell tumor of tendon sheath or pigmented villonodular synovitis) is a rare soft tissue tumor that arises from the tenosynovium of a tendon sheath or the synovium of a diarthrodial joint. This disease process occurs infrequently in the foot and ankle but can result in significant bone erosion and destructive changes of affected joints. These cases are challenging to treat, because the tumor most commonly presents in young, active patients and can be associated with extensive bone loss. We review a case of tenosynovial giant cell tumor of tendon sheath of the midfoot, which was treated with mass resection, structural femoral head allograft bone grafting, and internal fixation with dorsal plating. The patient had achieved successful bony fusion and acceptable functional outcomes at the final follow-up visit 40 months postoperatively.     

Giant cell tumor of tendon sheath simulating giant cell tumor of bone: report of a case

A 24-year-old male patient presented with a painful eccentric lytic lesion of the proximal tibial epiphysis with a soft tissue component. Clinical and radiological assessment led to the tentative diagnosis of aggressive giant cell tumor of bone. The patient was treated with curettage, high-speed burr, and cementation after intraoperative pathology consultation. The final pathological report indicated that the tumor was giant cell tumor of the tendon sheath with bone invasion. Although uncommon, GCTTS should be considered in the differential diagnosis of such lesions when there is a prominent soft tissue component. Although the resection was intralesional, the thermal effect of the cementation of the involved cavity and complete removal of the tendon sheath may allow successful local control conjecture of lesions that otherwise present with clinical and radiographic findings suggesting giant cell tumor of the bone.     

Intraosseous metacarpal involvement of giant cell tumor of the tendon sheath: report of 2 cases

Intraosseous phalangeal growth of giant cell tumor of the tendon sheath (GCTTS) is an uncommon manifestation of this tumor, but it is well known because of its potentially aggressive local growth. This article details the findings of 2 cases of previously unreported intraosseous metacarpal involvement of GCTTS. Differential diagnosis of a metacarpal lesion with decreased radiodensity on radiographs should include GCTTS.     

手部腱鞘巨细胞瘤45例临床分析及探讨其复发相关因素

目的 探讨腱鞘巨细胞瘤患者的性别、年龄、职业、肿瘤生长部位与肿瘤复发的关系.方法 回顾分析1997年2月-2007年2月的45例手部腱鞘巨细胞瘤住院患者的病史,并就其性别、年龄、肿瘤生长部位进行临床统计学分析.结果 高发年龄为21-30岁,占51.1%.男女性别比例基本为1:1.差异无统计学意义;发病部位右手(60.0%)明显高于左手(40.0%),差异有统计学意义.结论 局部切除是治疗腱鞘巨细胞瘤的最佳方案;对病理检测结果为生长活跃的肿瘤患者应做局部扩大切除术.     

上肢腱鞘巨细胞瘤术后复发相关因素分析

目的：了解上肢腱鞘巨细胞瘤患者的性别、年龄、肿瘤生长部位、术中化学处理情况和肿瘤术后复发的相关性。方法：回顾分析2000年1月至2011年8月47例上肢腱鞘巨细胞瘤住院患者的病史,对其性别、年龄、肿瘤生长部位、术中是否接受化学灭活处理、手术并发症、肿瘤复发情况及病理结果做统计和分析。本组女28例,男19例;年龄17～78岁,平均38.15岁。所有病例接受手术局部切除。14例术中使用化学方法灭活肿瘤细胞（术中使用乙醇或碘酒浸泡手术创面）。对患者定期随访,观察创口愈合情况、病理结果、肿瘤是否复发,并做必要的影像学检查。结果：47例平均随访53.89个月（22～129个月）,其中4例术中采用乙醇灭活的病例术后出现创口红肿、坏死组织排出、创口延迟愈合等并发症;15例报告肿瘤组织生长活跃,1例为低度恶性的腱鞘巨细胞瘤。术前X线发现有骨质破坏组术后复发率明显增高（P=0.003）;术中接受化学方法灭活的病例术后复发率小于未接受化学方法灭活病例（P=0.042）。结论：上肢腱鞘巨细胞瘤患者术后是否复发与肿瘤生长部位、是否有骨质破坏、是否采取术中化学灭活密切相关。局部切除是治疗上肢腱鞘巨细胞瘤的有效方案,配合术中化学方法灭活能够降低术后复发风险。如何在术中确定复发高危人群,降低其复发率及重建广泛切除肿瘤后的手功能是将来研究的重点和难点。     

Ganglion cysts and other tumor related conditions of the hand and wrist

Most regard ganglion, giant cell tumor of tendon sheath and epidermal inclusion cysts as tumor-like conditions as opposed to true neoplasms. Ganglion cysts are the most common lesion of the hand and wrist, accounting for 50% to 70% of all masses identified. The majority of ganglion cysts can be treated nonoperatively but when surgery is performed a low recurrence rate can be anticipated. Giant cell tumor of the tendon sheath hand epidermoid cysts are also common hand lesions that require surgical excision in most instances. Of the three, giant cell tumor of tendon sheath have the most notable recurrence rates. This article reviews the clinical presentations of these lesions as well as their proposed pathophysiology.     

手部恶性腱鞘巨细胞瘤七例报告

目的　探讨手部恶性腱鞘巨细胞瘤的诊断和治疗。方法　分析 7例恶性腱鞘巨细胞瘤的发病过程及治疗结果。其中 3例曾作广泛切除术 3次 ,每次术后均复发。 1例多次复发者作全手切除 ,4例作肿瘤切除及局部组织广泛切除。结果　 7例术后获得随访 4～ 6年 ,均未见复发及转移。结论　对有明显复发倾向的恶性腱鞘巨细胞瘤应考虑作截肢手术     

Giant cell tumors in the patellar tendon area

Giant cell tumor of the tendon sheath is a benign tumor typically presenting as a nontender mass around the hand and wrist. Giant cell tumor of the tendon sheath in large joints is typically larger and shows higher rates of local recurrence, as well as common features with pigmented villonodular synovitis. We describe two cases of giant cell tumors in the patellar tendon area that were treated successfully with arthroscopically assisted complete excision. Orthopedic surgeons must be aware of this entity to prevent unnecessary adjuvant therapy or recurrent excision.     

Multifocal giant cell tumors of tendon sheath along a single tendon: A case report with review of literature

The giant cell tumor of tendon sheath (GCTTS) or nodular tenosynovitis arises as discrete solitary nodule in the tendon sheath near joints of toes and fingers. Multifocal giant cell tumor of tendon sheath is a rare entity, of which the etiology is not yet fully understood and it is different from diffuse type of GCTTS. Diffuse type of GCTTS occurs around large joints having a main mass from which a small satellite nodule may arise. Multifocal GCTTS along a single tendon is a more rare entity. Herein, we describe a case of multifocal GCTTS along the tendon sheath of flexor digitorum profundus tendon of index finger. The patient was managed by surgical excision of the tumor swellings with no recurrence at two years follow up.     

Unusual presentation of a giant cell tumor of the tendon sheath in the foot

Giant cell tumor of the tendon sheath has frequently been described in the hand, but it is much less common in the foot. The case report presents an apparent cystic bony lesion of the proximal phalanx of the second toe of the foot. The operative findings and histological examination revealed a giant cell tumor of the tendon sheath that had eroded the phalanx. The case demonstrates that in the differential diagnosis of a cystic lesion of bone, extrinsic soft-tissue lesions should be considered.