髋臼邻关节骨囊肿的诊断与治疗

The diagnosis and therapeutics of the juxta-articular bone cyst in the acetabulum

目的探讨髋臼邻关节骨囊肿的诊断、鉴别诊断与治疗方法。方法回顾性分析1990年8月至2009年4月收治的19例髋臼邻关节骨囊肿患者的临床资料，男11例，女8例；年龄18-59岁，平均42．3岁。17例有髋关节酸痛不适症状，病程2个月至20年，中位时间为15个月。X线片均显示髋臼负重区近侧椭圆形或圆形溶骨性病变，紧贴软骨下骨，边界清晰，伴有硬化边缘。5例合并髋关节发育不良。刮除病变后予以髂骨植骨14例、异体松质骨颗粒植骨3例、人工骨植骨2例。结果术前18例确诊，14例依据X线片确诊，4例依据CT和MRI确诊。另1例诊断为单纯性骨囊肿。病灶长径2-4cm者16例，4-8cm者3例，病灶大小与是否有症状及病程长短无关。17例病灶位于髋臼负重面前上方，2例位于髋臼后上方。全部病例随访11个月至13年，平均6．2年，无囊肿复发。14例无症状，3例偶有髋部不适，2例髋关节发育不良者症状先改善后加重，出现关节间隙狭窄。结论刮除植骨治疗髋臼邻关节骨囊肿有效，其影像学上病灶分布特点表明病灶发生与应力集中有关。

Objective To discuss the diagnosis, differential diagnosis and therapeutics of the juxtaarticular bone cyst in the acetabulum. Methods Between August 1990 to April 2009, nineteen cases of clinical data of the juxta-articular bone cyst in the acetabulum data were collected from hospital records and analyzed retrospectively. There were 11 males and 8 females, with an average age of 42.3 years （range, 18- 59）. Seventeen patients felt an aching pain in the hip. The duration of symptoms was from 2 months to 20 years with the median 15 months. All the radiographs showed a well-demarcated oval or circular radiolueent defect, close to subchondral bone, and outlined by a thin rim of sclerotic bone. Five cases accompanied with developmental dysplasia of the hip. After curettage of the bone cyst, 14 patients received iliac crest autogenous bone grafts, 3 patients received xenoma spongy bone-graft particles, and 2 patients received artificial bone grafts. Results Fourteen patients were precisely diagnosed as bone cyst by radiograph, and 4 patients were diagnosed by CT and MRI. The major axes of the focus were 2-4 cm in 16 patients, and 4-8 cm in 3 patients. The sizes of the focus had no relationship with the symptoms and the course of the disease. Seventeen cases of the focus were located at the anterior superior of the bearing surface of the aeetabulum. All patients were successfully followed up from 11 months to 13 years, averaged 6.2 years, and no relapses occurred during the follow-up period in every case. Fourteen patients felt asymptomatic, 3 patients felt uncomfortable in hip occasionally, and 2 patients with developmental dysplasia of the hip felt ameliorated in the initial stage of the therapy, followed by aggravation accompanying the hip joint space narrow. Conclusion Bone graft after thorough curettage of the capsular space was an effective therapy for the juxta-articular bone cyst in the acetabulum, and the anatomic distribution of radiological lesions indicated that the stress concentration maybe the etiological factor of the bone cyst.