肩胛骨骨样骨瘤合并肩关节滑膜炎1例

患者,男,16岁.6个月前无明显诱因出现活动时右肩部疼痛,1个月后表现为夜间疼痛,服用非甾体类消炎药疼痛可明显缓解.病程中不伴发热,无夜间盗汗.查体:右肩关节无明显肿胀,无明显肌肉萎缩,肩关节外展受限(85°),肩关节周围及喙突下方压痛.     

Osteoid osteoma of the distal thumb phalanx: A case report

Osteoid osteomas of the hand are uncommon. Particularly, location in the thumb and involvement of the distal phalanx are very rarely reported. Long diagnostic delay and inadequate treatment are typical, since clinical features may mimic other causes more frequently found in the same site (post-traumatic, infective, rheumatic, neoplastic conditions, regional pain syndrome) and even the nail morphology may be altered, as in the reported case (watch-glass deformity). A case of an osteoid osteoma of the distal thumb phalanx in a 27-year-old man is presented, along with its clinical, radiographic and CT findings. In the Authors’ opinion, curettage should be considered the treatment of choice.     

Soft-tissue osteoma of the hand: case report

A soft-tissue osteoma is rare. Only 1 previous case involving the hand has been published. We report a 66-year-old man with a soft-tissue osteoma of the palm that was treated by marginal excision.     

Osteoid Osteoma of the Calcaneus: Percutaneous Radiofrequency Ablation

Osteoid osteoma of the foot can pose particular problems in diagnosis, especially when positioned in a juxta-articular location. It can cause reactive synovitis and simulate arthritis without periostitis. An atypical presentation may delay diagnosis and thus delay treatment. Different modes of treatment have been described including medical management with nonsteroidal, antiinflammatory drugs, and open surgical resection with intralesional, marginal, or wide surgical margins. In recent years, several computed tomography-guided percutaneous techniques have been used to achieve ablation of the nidus with minimal tissue invasion. We report a case of a 39-year-old man with an 8-month history of persistent foot pain who underwent percutaneous radiofrequency ablation of an osteoid osteoma involving the calcaneus. The patient related an immediate relief of pain and had no recurrence of symptoms or the lesion at 3-year follow-up.     

True posterior dislocation of subtalar joint: a case report

Posterior dislocation subtalar joint is rare and usually results from a high-velocity injury. Previous reports of all complete posterior dislocations of the subtalar joint have had some degree of a rotational component. We report a case of a true complete posterior dislocation of subtalar joint with no rotation.     

Foot and Ankle Osteoid Osteomas

Foot and ankle osteoid osteomas (OOs) are often cancellous or subperiosteal and rarely present with a periosteal reaction. Additionally, the large number of disorders included in the differential diagnosis and the nonspecific findings on radiographs complicate the diagnosis. We performed a manual search of the senior surgeon's hospitals' operating room records for the terms “benign bone tumor,” “foot,” “ankle,” and “osteoid osteoma” from January 2003 until December 2014. Of 87 surgically treated patients with lower extremity OOs, 9 patients (11%) with foot or ankle OOs were included. The mean age at presentation was 21 (range 6 to 30) years; all 9 (11%) patients were male. The patients were evaluated for swelling, pain, trauma history, night pain, response to pain relievers, duration of complaints, and interval to diagnosis. The mean follow-up period was 48?±?24 months, and no recurrences had developed. The mean American Orthopaedic Foot and Ankle Society scale score was 59.04?±?11 before surgery and 91.56?±?6 after surgery. The difference was statistically significant at p?≤?.0003. Most previous studies have been limited to case reports. The need for findings from a case series was an essential determinant of our decision to report our results. Patients usually have been treated conservatively, often for a long period. However, delays in treatment cause social, economic, and psychological damage. In conclusion, the presence of atypical findings on radiographs has resulted in a preference for magnetic resonance imaging instead of computed tomography; however, the diffuse soft tissue edema observed on MRI can lead to the use of long-term immobilization and a delay in the diagnosis.     

Osteoid osteoma following fracture of the distal tibia: A case report and literature review

Osteoid osteoma is a benign bone-forming lesion, characterised by its small size, its clearly demarcated outline and by the usual presence of a surrounding zone of reactive bone formation. It often poses a diagnostic challenge due to its ambiguous presentation. The aetiology of osteoid osteoma is poorly understood. The previous suggestion that osteoid osteoma was not associated with trauma or infection has been challenged by more recent literature raising the possibility that it could be a reactive or healing response or a phenomenon associated with the revascularisation process. This case report describes an unusual presentation of a post-traumatic osteoid osteoma. Two years following a tibial fracture treated non-operatively, the patient developed new pain at the previous fracture site. The pain was constant, relieved by non-steroidal analgesia and not associated with systemic upset. It was initially attributed to other more likely diagnoses such as osteomyelitis and neuropathic pain. Multiple investigations and interventions were undertaken prior to the diagnosis being obtained by surgical excision of the lesion and histological studies 3 years following the initiation of the discomfort. This case report should raise the index of clinical suspicion of osteoid osteoma occurring post fracture.     

Osteoid osteoma with a multicentric nidus: a case report and review of the literature

To date, 23 cases with osteoid osteoma (OO) including multiple nidi in single bone have been reported in the world literature. A case report of an 18-year-old boy with an OO on his left femoral neck, which contained double nidi is presented. Plain radiography, computed tomography (CT) and magnetic resonance imaging (MRI) of the proximal femur showed OO with a multicentric nidus. Bone scintigraphy demonstrated increased activity in the left femoral neck region. The tumor was removed with curettage and shaving using lateral approach. The patient was asymptomatic for 5 years after surgery.     

Arthrodesis for chronic lateral subtalar joint dislocation caused by posterior tibial tendon dysfunction: A case report

IntroductionAdult acquired flatfoot deformity (AAFD) caused by posterior tibial tendon dysfunction (PTTD) can lead to the development of peritalar subluxation (PTS) and much more rarely to lateral subtalar dislocation.Presentation of caseA 75-year-old woman was referred to our hospital with an approximately 15-year history of pain in her right foot without obvious trauma. The lateral shifting foot deformity had worsened in the previous 5 years. On presentation, she had tenderness over the talonavicular joint, and the skin overlying the talar head on the medial foot was taut. Imaging revealed lateral displacement of the calcaneus with simultaneous dislocation of the talonavicular and talocalcaneal joints. We diagnosed lateral subtalar dislocation including the talonavicular and talocalcaneal joints caused by PTTD, which we treated by reduction and fusion of the subtalar joint complex. The foot and ankle were immobilized with a cast for 6 weeks.DiscussionAt the 1-year follow-up visit, the patient reported no pain during daily activities, although flatfoot persisted.ConclusionWe report a rare case of chronic lateral subtalar dislocation caused by PTTD that was treated by fusion of the talonavicular and talocalcaneal joints.     

Congenital subtalar dislocation—A case report

Congenital dislocation of the subtalar joint is one of the rarest forms of presentation of a calcaneo-valgus foot. We report the second case of this type published; an 18-month female child aged was seen with calcaneo-valgus deformity of left foot since birth. She was walking over the medial malleolus and medial border of foot. Radiographs and 3D CT scan of the left foot confirmed the diagnosis of a congenital subtalar dislocation. Surgical correction was achieved through a posterolateral incision, and the reduced joint was fixed with a k-wires for 6 weeks; the foot was immobilized in below knee cast for another 6 weeks, and an ankle foot orthosis was used for another 3 years. At 3 years post-surgical follow up, the child has a plantigrade foot with no functional impairment. Follow up radiographs and 3D CT scan confirmed the maintenance of well aligned talo-calcaneal joint. This type of dislocation should be considered in the differential diagnosis of calcaneo-valgus foot; a clear understanding of the pathology, a precise operative reduction, and long-term use of orthosis results in a favourable outcome.     

7例足踝部骨样骨瘤的诊断与治疗分析

背景：骨样骨瘤是于1935年由Jaffe首次报道的一种良性成骨性疾患,具有界限清晰的局限性病灶。最常见的部位为股骨、胫骨等长干骨,而足踝部的骨样骨瘤较为少见。目的：研究足踝部骨样骨瘤的临床特点以及外科治疗效果。方法：回顾性分析2010年1月至2013年10月在我院足踝中心确诊的7例足踝部骨样骨瘤的临床资料,其中男5例,女2例,平均发病年龄21.5岁。受累部位：距骨5例,跟骨2例。发病至确诊时间平均为16个月（8~25个月）,症状为疼痛,服用非甾体抗炎药可缓解。2例发病之前有相关部位的外伤史。3例曾于我院或外院诊断为其他疾病,并行相关手术治疗。1例外院确诊骨样骨瘤,手术切除后1年复发。所有患者均接受肿瘤刮除＋植骨治疗。结果：术后平均随访14个月（2~24个月）,患者疼痛症状均消失,未见病灶复发,无植骨反应,无病理性骨折。结论：足踝部骨样骨瘤发病少见,其临床表现容易与其他疾病相混淆。所以,需要密切结合患病部位的临床表现、完善的影像学检查和准确的组织活检做出明确诊断,并给以相应治疗。     

Pain in Osteoid Osteoma: Histological Facts

Six cases of osteoid osteoma were studied histologically using the Gross technique. When the nidus is located centrally, it is reached by amyelinic fibers accompanying the vessel branches or as independent fibers. The pain is generally considered to reflect changes in vessel pressure and it could also be due to direct irritation of the nerve fibers included in or near the calcification focus.     

Osteoid osteoma: report of a case

An osteoid osteoma on the foot diagnosed by clinical, pathologic, and radiographic evaluation was described. The lesion is found predominantly in the long bones of the foot. A differential diagnosis of osteoma, osteoblastoma, and osteogenic sarcoma must be ruled out in order for proper management of the patient. The case of a solitary, bony lesion located at the base of the proximal phalanx of the fifth toe in a 38-year-old, white female was presented. No evidence of malignancy was found. The lesion was a hard, painful, palpable mass, located in the fourth left web space, and was excised completely. The skin defect was closed in order for proper syndactilization of the adjoining fourth and fifth digits. Two years post-operatively, the patient was asymptomatic with no evidence of reoccurrence.     

Percutaneous CT-guided radiofrequency ablation of osteoid osteoma: Potential Pitfalls and complications and how to avoid them

Targeted cannulation of the nidus and subsequent thermal ablation is the basis of CT-guided radiofrequency ablation (RFA) of osteoid osteoma, which is considered nowadays as the treatment of choice. The majority of complications during this procedure are due to thermal injury of adjacent structures. Specific measures as per the anatomical location of osteoid osteoma can avoid the majority of complications. This article enlists the possible complications and their necessary precautions and remedies to avoid these complications during CT-guided radiofrequency ablation of osteoid osteoma.     

跟骨骨折对距下关节接触特征影响的实验研究

[目的]研究载荷条件下跟骨骨折后距下关节接触特征的改变,为临床治疗提供依据。[方法]取6具包括完整足和胫腓骨远端15~20 cm的新鲜标本。剔除皮肤、肌肉和跟腱,保留除外距下关节后方及前中关节面外侧的关节囊部分,保持韧带和关节囊的完整。将压敏片插入距下关节的前中和后关节面,中立位状态下分别在500 N载荷下,对6具标本的距下关节进行加载,完成完整足的测试。然后模拟原始骨折线用微型摆动锯将跟骨后关节面分为前内和后外2块,接着按解剖复位、后外侧骨折块向跖侧移位2、5、10 mm等条件重复上述实验,记录距下关节接触特征的改变。[结果]完整距下后关节面平均受压面积为(275.67±46.02)mm2,所承载的平均应力为(1.83±0.56)MPa。跟骨后外侧骨折块向跖侧移位2 mm时,后关节面平均受压面积为(167.67±25.09)mm2,较完整跟骨受压面积显著下降(P<0.01)。后关节面所承载的应力在骨折移位2 mm时为(2.41±0.84)MPa,较完整跟骨承载应力显著增加(P<0.01)。而前中关节面的受压面积无明显改变(P>0.05)。前中关节面所受的应力仅在骨折移位10 mm时显著增加(P<0.05)。[结论]跟骨距下关节后关节面骨折移位≥2 mm即应手术复位。     

Osteoid osteoma: painful enlargement of the second toe

Osteoid osteomas involving the phalanges of the toes are a rare occurrence. We report a case of an osteoid osteoma of the distal phalanx of the second toe which was treated successfully with surgical excision. Although soft-tissue swelling with a typical clinical history is suggestive of the diagnosis, differentiation from subacute infection is subtle and may ultimately depend on tissue analysis.