成骨肉瘤早期临床表现特点

目的试图找出成骨肉瘤早期临床表现的特点和规律，为其早期诊断提供帮助。方法1984年4月～2002年10月，收治成骨肉瘤92例，对其中71例记录及检查齐全的患者首次就诊时的临床表现、诊断和确诊拖延的时间等进行调查和记录。男42例，女29例。年龄6～66岁，平均17．4岁。病程1～28周，所有患者均经病理诊断证实为四肢的成骨肉瘤，其中股骨下段38例，胫骨上段22例，股骨上段3例，腓骨上段3例，肱骨上段2例，胫骨下段2例，桡骨远端1例。结果71例患者中，有70例患者首次就诊为局部疼痛和／或包块。37例有昼夜无明显区别的持续性疼痛，23例为间隙性痛，11例为夜间痛。42例最初疼痛的出现与外伤有关，其中3例发生病理性骨折。首诊有局部包块者，医生拖延诊断时间1～14周，平均4周；未发现局部包块者，医生拖延诊断时间为3～30周，平均14周。首诊x线片检查者，医生拖延诊断时间1～20周，平均8周；未行x线片检查者，医生拖延诊断时间为4～30周，平均16周。结论间隙性和持续性疼痛及局部包块是成骨肉瘤患者早期最具特征性的表现，外伤往往是发现早期成骨肉瘤症状的一个因素。对关节周围出现疼痛且反复发作的青少年患者应给予细致的临床检查和观察。

EARLY CLINICAL MANIFESTATIONS OF OSTEOGENIC SARCOMA

Objective To investigate early clinical manifestations of osteogenic sarcoma to help establishment of an early diagnosis of the disease. Methods A total of 92 patients with osteogenic sarcoma in the extremities were admitted to our hospital from April 1984 to October 2002. Of the 92 patients, 71 (42 males and 29 females; averaged age 17.4 years, range 6-66 years; illness course 1-28 weeks) had a complete record of their medical history and examination. From their first medical visits, we obtained their clinical symptoms, physical sings, diagnoses, and duration of the delayed diagnoses. The patients were pathologically confirmed as having osteogenic sarcoma in the extremities, with the lesions located in the distal femur in 38 patients, proximal tibia in 22, proximal femur in 3, proximal fibula in 3, proximal humerus in 2, distal tibia in 2, and distal radius in 1. Results Of the 71 patients, 70 had a local pain and/or a palpable mass, 37 had a persistent pain with no difference between day and night, 23 had an intermittent pain, and 11 had a nocturnal pain. Of the 71 patients, 42 had an initial pain related to trauma, and 3 of the 42 patients had a pathologic fracture. The patients with the local mass had a delayed diagnosis of osteogenic sarcoma with a delayed duration of 1-14 weeks, averaged 4 weeks; however, the patients without the local mass had a delayed diagnosis of this disease, with a delayed duration of 3-30 weeks averaged 14 weeks. In the patients undergoing an X-ray examination at the first medical visit, the duration of the delayed diagnoses was 1-20 weeks, averaged 8 weeks, but in the patients without an X-ray examination at first, the duration was 4-30 weeks, averaged 16 weeks. Conclusion Intermittent and persistent pains and local masses are the most characteristic clinical manifestations in the early stage of osteogenic sarcoma. A history of trauma often helps to make a diagnosis of the disease. Careful clinical examination and observation should be given to adolescent patients who have a recurrent pain around the joint.