关于长骨纤维性皮质骨缺损和非骨化性纤维瘤的临床分析探讨

A clinical study of fibrous cortical defect and nonossifying fibroma in long bones

目的:为阐明纤维性皮质骨缺损(FCD)或骨干骺端皮质缺损(MFD)与非骨化性纤维瘤(NOF)发生、发展的衍变过程。方法:通过46例的临床追踪观察和相关文献复习,结合X线片及病理切片10余例从不同阶段,多角度多视野观察。结果:FCD或MFD以4～20岁的青少年及儿童多见,以阵发性疼痛,伴短暂的功能障碍就诊者23例占50%。早期X线片上可见圆形或椭圆形低密度骨皮质缺损模糊病灶。随着病程延长,灶周边界由模糊到清晰,可出现硬化缘,但无骨膜反应,可以单骨单发,亦可单骨多发或多骨多发。治疗及时合理,或自身抵抗力强时,病灶可停留于局限化的静止状态、或缩小、消退、骨化或钙化成“骨岛”。若治疗不当,或自身抵抗力低,或再损伤,疼痛可反复发作致病灶扩大。呈活跃性持续生长、可出现畸形或病理性骨折。本组中有16例占34.8%,此称NOF即非骨化性纤维瘤(属真性肿瘤)。若只行病灶区刮除植骨术未行灭活,则极易复发、扩散、甚至恶性变。结论:(1)NOF的早期病损就是FCD,其同义语又称MFD。它们同属于骨内起源于纤维性病损的一类病变,只是发展的不同阶段而已。(2)发病与创伤紧密相关,本组有85.9%的病例有确切创伤史。(3)各种影像学所见实质上是骨骼损伤后由纤维修复到成骨受阻的转化过程停留在某一临床阶段时的特殊表现。

Objective:To describe the origin and development of Fibrous Cortical defect (FCD) 〔or Metaphyseal Fibrous Defect (MFD)〕 and Nonossifying fibroma (NOF).Method:A clinical follow-up in 46 patients was made and correlated data was reviewed,combined with X-ray and pathological examination of more than 10 patients in various period and sights.Result:FCD(or MFD) often occured in 4~20 children or youngsters.The main complaint was paroxysmal pain and temporary disfunction in 23 pafients(50%).X-ray in early period indicateed the round or ellipse,low density and vague cortical defect.With the extention of disease course,the edge of focal lesion became clear and sclerotic,but no periosteal reaction.The focus could exist in single or multiple bones,or multiple focuses in single bone.Under effective treatment or good autoimmunity,the focus could stay in a localized static stage,or decrease,disappear and be ossified or calcified into a “bone island”.Otherwise,the focus could actively and persistently grow with obstinate pain,deformity and pathologic fracture.Sixteen patients(34.8%) were diagnosed as NOF.If the focus was only treated by cureltage and bone graft but not inactivating,it would have highly recurring,diffusing and cancerating risk.Conclusion:(1)The early focal lesion of NOF is FCD whose synonym is MFD.Both of them belong to osteogenic fibrous tumor,which are just in different growing stage.(2) The morbidit is highly correlated with trauma.85.9% patients in our group have categorical wound history.(3) Observation of NOF and FCD by various image analysis is virtually the different show of development staying in a certain stage,which indicates the focal lesion is developing romfibrous plerosis to osteogenesis disturbance after bone trauma.