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: Benign Osteoblastic Tumor of the Lumbar L4 Transverse Process Associated with Radicular Pain: A Case Report

Osteoid osteomas of the spine are benign bone tumors typically presenting with progressive pain without neurological deficit. This report presents a case of an osteoid osteoma in the lumbar spine associated with radicular pain. The patient, a young male athlete, presented with severe chronic nightly left low‐back pain radiated to the ipsilateral lower extremity who failed to respond to physical therapy and analgesic medications. Initial radiologic examination was reported as normal, but closer inspection of the T1‐ and T2‐weighted magnetic resonance image as well as technetium‐99m total body bone scan and a computed tomography scan revealed a bony lesion in the left transverse process of the L4 vertebra consistent with the diagnosis of osteoid osteoma. A selective L3 nerve root block provided significant relief. Surgical excision of the osteoid osteoma resolved the symptoms. This case emphasizes the importance of early suspicion and diagnostic interventions in the detection and treatment of osteoid osteoma.     

Walker 256/B malignant breast cancer cells disrupt osteoclast cytomorphometry and activity in rats: Modulation by α-tocopherol acetate

We examined the effects of vitamin E supplementation (VES) on osteoclast (OC) resorbing activity and cytomorphometry in Walker 256/B tumor osteolytic rats.     

骨样骨瘤全身骨显像和SPECT/CT显像的图像特征分析

目的分析骨样骨瘤全身骨显像(WBS)和SPECT/CT显像的图像特征。方法回顾性纳入2010年1月至2018年12月间西南医科大学附属医院经病理证实且以局部疼痛为主要表现的70例骨样骨瘤患者(男50例,女20例,年龄4~66岁),分析患者99Tcm-亚甲基二膦酸盐(MDP)平面显像及SPECT/CT显像的图像特点。结果WBS联合SPECT/CT显像发现70个病灶,以股骨(37.1%,26/70)和胫骨(35.7%,25/70)病灶多见;56例行三时相骨显像的患者病灶与健侧放射性比值(T/NT)为3.7±1.2。WBS示病灶摄取呈圆形(或类圆形)者48个(68.6%,48/70),呈梭形者21个(30.0%,21/70),不规则形状者1个(1.4%,1/70);SPECT/CT显像示病灶摄取呈圆形(或类圆形)者69个(98.6%,69/70),不规则形状者1个(1.4%,1/70)。WBS中表现为"双灰度征"的病灶有48个(68.6%,48/70);而SPECT/CT显像示59个(84.3%,59/70)病灶表现为"双灰度征"。SPECT/CT显像示59个(84.3%,59/70)病灶有瘤巢,27个(38.6%,27/70)病灶出现钙化或骨化(即"靶征")。结论骨样骨瘤的典型WBS及SPECT/CT显像征象包括"双灰度征"、瘤巢及"靶征"等,这些征象有助于骨样骨瘤的诊断。     

骨母细胞瘤术后复发恶变的初步探讨

本文对少见骨母细胞瘤术后复发、恶变 ,结合国内外文献复习 ,就其命名 ,误诊原因、诊断及治疗等方面作一初步探讨。     

髋关节周围骨样骨瘤的CT引导下经皮旋切治疗

目的探讨CT引导下髋关节周围骨样骨瘤经皮旋切治疗的疗效。方法2006年5月至2008年12月,共收治8例髋关节周围骨样骨瘤患者,其中男5例,女性3例,年龄8～28岁,平均18.4岁,临床表现及影像资料均支持骨样骨瘤诊断,均于CT引导下经行皮骨样骨瘤旋切术。术前对整个病灶区采用1～2mm薄层CT扫描,然后选择瘤巢中心,于导引针引导下行环锯完全切除瘤巢。结果8例患者均顺利取出瘤巢,3例手术后症状缓解,5例手术后次日症状缓解,无明显手术并发症发生。随访6～24个月（平均14.6个月）,患者症状完全缓解,无1例复发。结论CT引导下经皮旋切髋关节周围骨样骨瘤治疗微创、简便、安全、疗效确定,有助于手术安全及患者快速康复。     

计算机导航辅助经皮射频消融治疗骨样骨瘤13例报告

目的：探讨计算机导航技术辅助经皮射频消融治疗骨样骨瘤手术方法和临床效果。方法回顾性分析2011年6月至2012年11月,我科应用计算机导航辅助经皮射频消融治疗骨样骨瘤13例的临床资料,其中男12例,女1例,平均16.5（8～36）岁。术前均经局部X线、CT、MRI明确诊断。肿瘤位于股骨干4例、股骨粗隆2例、股骨颈2例、股骨髁2例、胫骨干2例、跟骨1例。13例均采用Iso-C 3D C型臂术中实时导航,计算机软件均使用Stryker公司的脊柱导航软件。术中导航指引定位,骨活检针（9G ）精确到达瘤巢,行穿刺活检,保留套筒,将射频针导入瘤巢,90℃消融6 min。术后进行随访,并采用疼痛视觉类比评分法（ VAS ）和术后X线、CT判断疗效。结果13例均获11.2（4～20）个月的随访。全部病例均完成计算机导航辅助下射频消融手术,11例组织病理学确诊为骨样骨瘤,2例组织学无法诊断,病理确诊率85%。术后疼痛即刻缓解,VAS评分显著降低。术前平均4.7,术后3天1.3,术后3个月为0.1,差异有统计学意义（ P＜0.05）。全部病例随访未见肿瘤复发和疼痛复发。结论经皮射频消融治疗骨样骨瘤是一种简单、安全、有效的治疗方法。计算机导航技术的应用,使术中瘤巢定位更精确,使手术治疗的微创化成为现实。     

The diagnostic and therapeutic challenge of femoral head osteoid osteoma presenting as thigh pain: a case report

Osteoid osteoma, an infrequent but important cause of musculoskeletal pain, is often difficult to diagnose. We present a case of a 31-year-old man who, for 2 years, had left groin pain radiating to the thigh. Symptoms began 1 month after a motorcycle crash in which he sustained only shin abrasions. Initial spine and hip radiographs were negative. Treatment with naproxen provided significant relief, but the symptoms gradually worsened over 6 months. An electromyogram and lumbar magnetic resonance imaging (MRI) of the left lower leg were unremarkable. Hip MRI revealed edema without fracture. Prophylactic femoral pinning for impending stress fracture provided no relief. Rheumatologic evaluation revealed normal serologies and synovial fluid. Cyclobenzaprine and sulfasalazine were started and provided mild relief. At presentation to our institution, he was in significant discomfort, but could ride a bicycle for exercise and was completing a home exercise program. He had antalgic gait and globally restricted hip motion with end-range pain. A neurologic examination showed no abnormalities. Hip and pelvis computed tomography scan revealed increased sclerosis of the femoral head, with a central lucency suggestive of osteoid osteoma. This was confirmed by biopsy. Radiofrequency ablation provided significant symptom relief.     

病理性骨化的X线形态及诊断价值

目的 分析病理性骨化的X线形态，探讨其在X线诊断中的价值。方法 对243例X线上表现有骨化的病例进行X线形态的回顾性分析，根据其表现特点进行分类研究。结果 243例病理性骨化中，单表现骨化者231例，伴有钙化者12例；其中反应性骨化183例、肿瘤性骨样基质骨化51例、非肿瘤性骨样基质骨化13例、特异性骨化1例。各种骨化都有其独特的X线表现特点。结论 X线上病理性骨化代表着独特的组织学属性。其X线形态的不同对其疾病的X线诊断有着重要价值。     

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.