骨样骨瘤的诊断与治疗

目的:研究骨样骨瘤的临床特点以及外科治疗效果,提高诊治水平。方法:回顾性分析1997年1月至2009年10月确诊的35例骨样骨瘤的临床资料,其中男25例,女10例,平均发病年龄21岁(6～49岁)。最常见的部位为胫骨(13例)和股骨(7例)。发病至确诊时间平均为12个月(1～24个月),典型的症状为疼痛,夜间加重,服用非甾体抗炎药可缓解,影像学表现为一圆形或卵圆形的瘤巢。所有患者均经手术治疗:单纯肿瘤切除9例,肿瘤刮除或切除人工骨或自体骨植骨19例,肿瘤刮除或切除植骨固定7例。结果:术后平均随访49个月(2个月～12年),所有患者疼痛症状均消失,未见病灶复发。1例术后4个月出现胫骨病理性骨折,经钢板螺钉内固定后治愈。1例术后5年窦道形成,行窦道切除、髓内钉取出、清创术后治愈。结论:根据典型临床表现、影像学特点,骨样骨瘤的诊断并不困难,为缓解症状、提高生活质量、预防远期并发症,确诊后应尽早手术治疗。

Diagnosis and treatment of osteoid osteoma

Objective: To study the clinical features and surgical treatment of osteoid osteoma and improve the diagnostic therapeutic level. Methods: Clinical data of 35 patients(25 males and 10 females) with osteoid osteoma diagnosed and treated between January 1997 to October 2009 were retrospectively reviewed. The average age was 21 years (ranged,6 to 49 years). The average interval time between onset of symptoms and diagnosis was 12 months(ranged,1 to 24 months). The most common sites were the tibia(13 patients) and the femurs(7 patients). The most common presenting complaints for patients with osteoid osteoma was pain which usually responded to NSAIDs and was generally more severe at night. The imaging manifestations revealed a circular or oval nidus. All the patients underwent surgical treatment. The tumors were treated with curettage or excision with autograft or allograft in 19 patients,simple surgical resection in 9 patients,curettage or excision with autograft or allograft and fixation in 7 patients. Results: The mean follow- up period was 49 months(ranged,2 months to 12 years). The symptom of pain disappeared after operation. There were no evidence of recurrence. Tibial pathological fracture happened in one patient 4 months postoperatively,and the patient got healing after plate-screw internal fixation. One patient with sinus formation 5 years postoperatively got wound healing after sinus resection,intramedullary nail removal and debridement. Conclusion: According to the typical clinical presentation,radiographic findings,the diagnosis of osteoid osteoma is not difficult. Once the diagnosis is confirmed,the operation should be carried out as early as possible to relieve the symptoms,improve the quality of life and prevent long-term complications.