儿童骨皮质破坏性椎板骨样骨瘤的诊治

目的 介绍儿童骨皮质破坏性椎板骨样骨瘤的诊断和治疗方法。方法 详述2例儿童椎板骨样骨瘤的临床症状和体征、X线检查、CT和骨扫描影像以及治疗方法的选择，结合病例复习相关文献。结果 2例患儿的肿瘤在手术切除后疼痛、脊柱侧凸等症状和体征消失。结论 手术是治疗椎板骨样骨瘤确实有效的方法。     

Osteoid osteoma mimicking Brodie's abscess in a 13‐year‐old girl

Osteoid osteoma is a solitary, benign lesion of bone causing significant nocturnal pain. Magnetic resonance imaging (MRI), computed tomography (CT), and bone scan are commonly used in this diagnosis. A case of osteoid osteoma of the distal femur mimicking chronic osteomyelitis with Brodie's abscess is reported and discussed. Initial radiographs and MRI showed a lesion of the distal femur consistent with subacute osteomyelitis with a Brodie's abscess. Because primary malignant tumor could not be eliminated, surgical biopsy was carried out. Histological examination showed a typical nidus consistent with the diagnosis of osteoid osteoma. Subacute osteomyelitis (Brodie's abscess) may be difficult to distinguish from other malignant or benign bone lesions as osteoid osteoma. CT usually is recommended as the best imaging procedure to identify the nidus and confirm the diagnosis. MRI also can be used for this purpose. Surgical biopsy remains mandatory for unclear lesions before deciding on appropriate treatment.     

Multicentric osteoid osteoma with a nidus located in the epiphysis

We present a 13-year-old girl who was referred to our clinic with a 5-month history of right leg pain relieved by salicylates. Initial CT examination demonstrated a lesion in the posterior tibial cortex in keeping with an osteoid osteoma. This was resected and the diagnosis confirmed by histology. However, her pain recurred 2 weeks after the operation and further imaging identified a further nidus in the epiphysis. We present the imaging findings in this unique case of multicentric osteoid osteoma with one nidus located in the epiphysis.     

儿童骨样骨瘤的诊断及治疗体会

目的 分析7例骨样骨瘤的临床及影像学特点，总结诊断经验，探讨治疗方法。方法 对7例骨样骨瘤患者的诊断和治疗进行回顾性分析，病变位于股骨近端4例，胫骨中上段、距骨各1例，股骨远端干骺端和胫骨上端干骺端同时存在1例。2例患者施行传统的手术方法，将整块硬化骨质及瘤巢一并切除，5例患者在C型臂引导下切除瘤巢，所有病例切除组织术后均送病理检查。结果 7例患者术后临床症状均消失，病理报告均为骨样骨瘤，随访2月～8年余无1例复发。结论 骨样骨瘤的诊断主要根据典型的夜间疼痛为主的临床症状及影像学检查发现瘤巢，尤其是CT诊断价值最大；瘤巢的准确定位及彻底切除是获得良好治疗效果的关键，C型臂引导下手术切除局部病灶是较为理想的治疗方式。     

Osteoid osteomas: a pain in the night diagnosis

Osteoid osteoma is a common benign bone-forming lesion that is composed of a nidus of vascular osteoid tissue and woven bone lined by osteoblasts. It is frequently associated with considerable surrounding inflammation. The diagnosis is usually straightforward when imaging reveals a radiolucent nidus surrounded by variable degrees of reactive sclerosis. However, the diagnosis can be elusive when osteoid osteomas occur in atypical locations, as they may have a nonspecific and misleading appearance on different imaging modalities, particularly on MRI. The purpose of this pictorial essay is to review the typical and atypical features of osteoid osteomas on different imaging modalities, and the appearance of osteoid osteomas in different locations. We also review growth disturbances caused by osteoid osteomas and potential mimickers, with imaging characteristics that can aid in diagnosis.     

Osteoid osteoma and benign osteoblastoma in childhood.

Three cases of osteoid osteoma and one of benign osteoblastoma in children are described. The main complaint was severe pain which was worse at night; it was relieved by aspirin or other analgesics. The diagnosis was made on clinical and radiological grounds and was confirmed on histological examination of the central nidus removed at operation. The pain was relieved in the patients with osteoid osteoma, and it was very much less after operative removal of the benign osteoblastoma. Both conditions are probably variations of the same disease process, depending on the anatomical site and the type of bone affected.     

Efficacy of percutaneous radiofrequency ablation of osteoid osteoma in children

Background Percutaneous radiofrequency (RF) ablation of osteoid osteoma has high technical and clinical success rates. However, there are limited data on its use in the treatment of osteoid osteoma in children. Objective To assess the safety and efficacy of CT-guided percutaneous RF ablation of osteoid osteoma in children and compare the outcomes with published data on its use in patients unselected for age. Materials and methods From January 2003 to July 2006, 23 children with osteoid osteoma were treated with CT-guided RF ablation using a straight rigid electrode. Their mean age was 11 years (range 3.5–16 years) and there were 15 boys and 8 girls. The procedures were carried out under general anaesthesia. Follow-up was performed to assess technical and clinical outcome. The mean follow-up period was 2.5 years (range 13–49 months). Results Technical success was achieved in 21 children (91.3%). Failure occurred in two children, in one due to failure to adequately localize the nidus within the dense sclerosis and in the other because of a short ablation time (2 min) because he developed hyperthermia. Clinical success was achieved in 18 patients within 2–5 days (primary clinical success rate 78.2%).These patients were allowed to fully weight-bear and function without limitation 1 week after the procedure. Pain recurrence was observed in two patients; one was treated successfully with a second ablation after 6 months (secondary clinical success rate 82.6%). Hyperthermia was observed in two patients during the procedure. Three other minor complications were observed: wound infection in one child and skin burn in two children. No major immediate or delayed complications were observed. Conclusion Percutaneous CT-guided RF ablation is an effective and safe minimally invasive procedure for the treatment of osteoid osteoma in children. It has high technical and clinical success rates that are slightly lower than those of patients with a wider range of ages.     

Percutaneous resection of osteoid osteoma under CT guidance in eight children

In eight children with suspected osteoid osteoma, a percutaneous resection under CT guidance was performed. The specificdrill resection system we currently use includes a 7-mm-diameter toothed drill. Osteoid osteomas were located in the appendicular skeleton in seven children and in the spine (second lumbar vertebral body) in one. All eight patients were successfully treated with complete relief of pain. There was no recurrence of symptoms during a follow-up period of 8–35 months. CT guidance was accurate enough to allow a focal bone excision, and no subsequent bone repair was needed. Histological confirmation was obtained in all cases. This simple and safe technique, when feasible, seems to be an effective means of treatment of osteoid osteoma in children.     

The management of osteoid osteoma: updates and controversies

PURPOSE OF REVIEW: Osteoid osteoma is a benign painful bone tumor usually found in the lower extremities of children and young adults. It has been traditionally treated by surgical excision. Despite the small size of the lesion, the operative procedure for its removal can be extensive, but still sometimes remains incomplete. The purpose of this review is to highlight and discuss current developments in the management of osteoid osteoma. RECENT FINDINGS: During the past decade, efforts were deployed to minimize bone removal, lessen the risk of pathologic fracture and the need for bone grafting, and thereby shorten the period of convalescence. Improved methods for the precise localization of an osteoid osteoma with use of radioisotope scanning or computed tomography scan have made it possible to treat this lesion with more limited and effective operations, mainly in deep and non-easily accessible osteoid osteomas. SUMMARY: Although they bear the criticism of lacking histological proof for diagnosis of osteoid osteoma, minimally invasive techniques, such as computed tomography-guided percutaneous radiofrequency thermal ablation and laser photocoagulation have become the methods of choice for the treatment of all localizations except those in contact with neural structures (awaiting further research and experience), provided that the diagnosis is based on a typical clinical, scintigraphic and computed tomography presentation.     

Primary vertebral tumours in children

20 cases of primary benign and malignant bone tumours in children were reported. The most common tumours were Ewing's sarcoma, aneurysmal bone cyst, benign osteoblastoma and osteoid osteoma. Some rare primary bone tumours in children (osteochondroma, chondroblastoma?, primary lymphoma of bone and neurofibromatosis with unusual cervical spinal changes) were also reported. The authors believe that radiographic findings together with clinical history and clinical examination may yield a high percentage of accurate diagnoses. Although microscopy is essential in the final diagnosis, the microscopic report should be viewed with caution.     

Primary bone tumours of the hand

Twenty-one primary bone tumours of the hand in children from 8 paediatric hospitals are reported. Osteochondromas and enchondromas were not included. Our material consisted of 16 patients with common tumours (3 Ewing's sarcoma, 5 aneurysmal bone cyst, 6 osteoid osteoma and 2 epidermoid cyst) and 5 patients with uncommon tumours (osteoma, simple bone cyst, haemangiopericytoma, capillary angiomatous tumour and benign ossifying fibroma or osteoblastoma). The X-ray diagnosis of the common tumours should have high concordance with histology, whereas that of uncommon tumours is much more difficult and uncertain. The characteristic features of Ewing's sarcoma are stressed as all our children with this tumour had a delayed diagnosis and a fatal outcome. Differential diagnosis with other short tubular bone lesions of the hand - specifically osteomyelitis - is discussed and the possibilities of microscopic diagnosis are stressed.     

Chronic sclerosing osteomyelitis (so-called Garré's). Review of 12 cases

This study reports 12 cases of chronic sclerosing osteomyelitis in children. The authors recall the past history of this disease and describe the clinical, radiological and pathological picture found nowadays. They insist upon the salient features that allow to differentiate this lesion from other types of infectious osteomyelitis and osteoid osteoma.     

Histological study of osteoid osteoma's blood supply.

The osteoid osteoma is a painful lesion with a special predilection for the femur and tibia of young patients. Although the lesion has been described as richly innervated, its vascular supply has not been critically appraised to date in the pathology literature. To this end, we have undertaken a morphological study of 16 archival cases of osteoid osteoma, focusing primarily on the patterns of vascularization, utilizing traditional histological and immunohistochemical approaches. The study demonstrated that a prominent arterial and arteriolar blood supply was a constant finding within the various zones of soft tissues, skeletal muscle, and bone surrounding the nidus. It also showed that the caliber of the vessels underwent gradual attenuation throughout their centripetal course toward the nidus, where the vessels lost their muscularis as they merged into the capillary network of the nidus. Immunostaining with antibodies to neurofilament and S100 proteins revealed a pattern of innervation that was overall less exuberant than that described in some reports and that was virtually absent from the nidus. Taken together with data reported in the radiological literature, our findings lead us to wonder whether the osteoid osteoma may represent a response to the local stimulation of bony tissue by a primarily aberrant vasculature, a hypothesis that warrants further elucidation using state-of-the-art imaging approaches.     

Percutaneous treatment of osteoid osteoma by CT-guided drilling resection in pediatric patients

Background: Osteoid osteoma is a painful, benign, small osteogenic bone tumor. For a long time, surgery was the only treatment for these lesions. Different minimally invasive therapeutic techniques have been proposed. We report our experience in the treatment of osteoid osteoma by CT-guided drilling resection in pediatric patients. Objective: To evaluate the efficacy of CT-guided percutaneous drilling resection as a minimally invasive therapy for osteoid osteoma in children. Materials and methods: Over a 5-year period, 18 patients (age range 6–17 years, mean age 11.6 years) with osteoid osteomas (femur, n=10; tibia, n=5; humerus, n=2; vertebral body, n=1) were treated with this technique. All procedures were performed under general anesthesia. Results: All procedures were technically successful. Clinical success was achieved in 94.5% of patients (17/18). Only one patient had recurrence of symptoms 8 months after percutaneous resection and was surgically retreated. There were no complications. Conclusion: CT-guided percutaneous drilling resection is a safe, simple and effective minimally invasive technique for the treatment of osteoid osteoma in pediatric patients.     

Isotope bone scans in the assessment of children with hip pain or limp

Bone scans from 43 children referred with hip pain of uncertain cause were reviewed. The bone scan was abnormal in 36 patients: normal in 7. In 12 the findings were diagnostic: osteomyelitis, osteoid osteoma, osteomyelitis with septic arthritis, Perthes' Disease and juvenile chronic arthritis. Twenty-four patients had abnormal scans including diffuse periarticular increase and of these 18 had transient synovitis. Immobilisation and trauma accounted for the remainder. Isotope bone scans have been found to be a valuable investigation in children presenting with hip pain or limp, where the x-rays may appear normal or nondiagnostic.     

Neurological manifestations of osteoid osteoma.

The clinical and radiological features of 38 children with osteoid osteomas were analysed retrospectively. Twenty nine patients had lesions of the femur (n = 17) or tibia (n = 12). The mean duration from the onset of symptoms to diagnosis was 13.8 months. In seven patients the history of pain and abnormalities on examination suggested a possible neurological disorder. Fourteen of 29 patients (48%) with femoral or tibial osteomas had localised muscle atrophy, and 10 patients (34%) had diminished or absent deep tendon reflexes in the affected limb. Two patients had painless lesions. Six patients had normal plain radiographs. Delay in the diagnosis of osteoid osteoma may be prevented by the knowledge that pain may be referred or radicular, that the concomitant occurrence of muscle atrophy and depressed deep tendon reflexes are relatively common findings, and that the characteristic radiological features may only appear late in the course of the disease.     

Osteoid osteoma: localization by intraoperative magnification scintigraphy

Surgical localization of osteoid osteomas is a major problem in the diagnosis and therapy of this lesion. Visual, tactile, and radiographic localization is often equivocal and as a consequence incomplete excision of the tumor, or excessive removal of bone may result. We performed magnification intraoperative bone scintigraphy using a portable gamma camera and a radioactive pointer in six patients with osteoid osteoma. Accurate localization and complete removal of the tumor was achieved in all six with only minimal delays in the surgical procedure. The advantages of this technique and recommendations for its use are discussed.     

Percutaneous radiofrequency treatment of osteoid osteoma

Osteoid osteoma is a small osteogenic tumor usually found in the lower extremity of children and young adults. Although these lesions are benign and rarely progress, they present distinctive pain symptoms that frequently require medical intervention. This article reviews surgical, medical, and percutaneous techniques for treatment of osteoid osteoma, emphasizing the value of percutaneous radiofrequency treatment.     

学龄期儿童胫骨疲劳性骨折

目的：掌握学龄期儿童胫骨疲劳性骨折特点并正确诊断。方法：分析临床资料比较齐全的９例患儿。结果：临床特点是活动后疼痛，休息后好转，无夜间痛；局部压痛肿胀，应力试验时疼痛；Ｘ线片开始２周～４个月可能为阴性，随后表现局部骨膜反应，进而骨膜下骨髓内骨痂，后期形成新骨。治疗采取保守治疗，石膏固定。结论：学龄期胫骨疲劳性骨折的诊断，要注意与骨髓炎、骨肉瘤和骨样骨瘤区别，预后良好。     

Slipped epiphyses in renal osteodystrophy.

Clinical, biochemical, roentgenological, and histological features of slipped epiphyses (epiphysiolysis) in 11 out of 112 children with renal osteodystrophy have been analysed. Characteristic age-related patterns of involvement of different epiphyses are described. Quantitative measurements of iliac bone histology, serum parathyroid hormone levels, and clinical history show the presence of more advanced osteitis fibrosa in children with epiphysiolysis than in those without. A good correlation was found between serum parathormone levels and osteoclastic resorption, endosteal fibrosis as well as osteoid. Histological studies show that the radiolucent zone between the epiphyseal ossification centre and the metaphysis in x-rays is not caused by accumulation of cartilage and chondro-osteoid (as usually found in vitamin D deficiency rickets) but by the accumulation of woven bone and/or fibrous tissue. The response to vitamin D therapy in most cases was good. Parathyroidectomy was required in only one case.