手及腕部骨样骨瘤的临床特点及误诊因素

Clinical features and misdiagnosis factors of osteoid osteoma in hand and wrist

目的总结手及腕部骨样骨瘤的临床特点,分析导致误诊的因素。方法自2017年1月至2018年6月我科收治3例手及腕部骨样骨瘤患者,回顾临床表现、辅助检查结果以及既往就诊经历,归纳手及腕部骨样骨瘤的临床特点,分析可能误诊的原因。结果3例患者术后伤口均I期愈合,病理结果为骨样骨瘤合并慢性炎性反应。平均随访时间为10个月,骨样骨瘤无复发,受累关节活动度较术前显著改善,病变部位无肿胀及疼痛感,按照中华医学会手外科学会上肢部分功能评定试用标准评定均为优。结论手及腕部骨样骨瘤病例罕见,临床症状的不典型性、影像学表现的多样性以及病史的复杂性是导致误诊的三个主要因素。

Objective To summarize the clinical features of osteoid osteoma in hand and wrist and analyze the factors leading to misdiagnosis. Methods From January 2017 to June 2018, three patients with osteoid osteoma in hand and wrist were treated in our department. The clinical manifestations, the results of auxiliary examinations and previous experience of treatment were reviewed. The clinical characteristics of osteoid osteoma in hand and wrist were summarized, and the possible reasons of misdiagnosis were analyzed. Results All the wounds of 3 patients achieved primary healing after operation. The pathological results were osteoid osteoma with chronic inflammation. The average follow-up time was 10 months. There was no recurrence of osteoid osteoma. The range of motion of the affected joints was significantly improved compared with that before operation. No swelling or pain occurred in the lesion site. According to the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were all excellent. Conclusion The osteoid osteoma in hand and wrist is rare. The atypical clinical symptoms, the diversity of imaging manifestations and the complexity of medical histoiy are the three main factors leading to misdiagnosis.