甲下外生性骨疣9例

Subungual exostosis:9-case report

目的:探讨甲下外生性骨疣的临床、组织病理学特点及治疗方法。方法:回顾分析西京医院全军皮肤病研究所2005—2010年间诊断和治疗的9例甲下外生性骨疣患者的临床、组织病理学及外科治疗特点。结果:男性5例,女性4例,发病年龄8～44岁,平均12岁。临床表现为指(趾)甲下或远端缓慢增长的外生性结节肿块,质硬,部分患者疼痛明显,伴有不同程度的指(趾)甲变形或缺损。X线检查示指(趾)骨背侧或偏于一侧骨性增生物。组织病理检查示真皮内类似骨刺的成熟骨结构,分为4层:纤维细胞层、成纤维细胞层、纤维软骨层和软骨化骨层。手术切除后皮损无复发。结论:甲下外生性骨疣是多发于青少年的单发良性骨软骨增生性病变,发生于指(趾)末节骨的远端,结合临床、病理学检查和X线可确诊。外科手术切除治疗可痊愈。

Objective： To analyze the clinico-histological features and the surgical treatment of subungual exostosis. Methods： Nine cases of subungual exostosis were retrospectively analyzed, which were diagnosed at the Department of Dermatology of Xi- jing Hospital from 2005 to 2010. Results： The patients included 5 males and 4 females, and their age at the onset of the disease was 12 year-old on average （from 8 to 44 years old）. Clinically, a painful or painless nodule slowly enlarged under the nail or on the distal ends of the fingers or toes, with deformed or defected nail plates at different extent. Radiography reveals osseous protu- berance from the dorsal side or distal margin of the terminal phalanx. The histopathology showed bony spur -like mature bone with a fibrocartilaginous cap in the deep dermis, composed of 4 layers： fibrous tunic, fibroblast tunic, fibrocartilage tunic and os cartilaginea tunic. There was no recurrence after surgical excision. Conclusion： Subungual exostosis is a benign osteochondral tu- mor located in the distal phalanges, mostly affecting adolescents and young adults. The diagnosis is made according to the medical history, the histopathological examination and the radiographic findings. Surgical excision is an effective treatment.