髌骨软骨母细胞瘤临床诊疗经验并文献复习

Clinical diagnosis and treatment of chondroblastoma in patella:Experience and review of the literature

目的探讨髌骨软骨母细胞瘤的临床诊断、鉴别及治疗方法并对相关文献进行复习,以增强对此病的认识和理解。方法报道华中科技大学同济医学院附属同济医院2014年7月至2022年1月收治的髌骨软骨母细胞瘤患者3例,对患者进行病史采集、体格检查及影像学扫描,发现髌骨内呈单囊性或多囊性膨胀性骨破坏表现,完善术前检查后行髌骨病变囊内刮除、囊壁电烧并异体/自体骨植骨手术,其中1例因病理性骨折行克氏针内固定并“8”字钢丝捆扎。结果术后病理诊断皆为髌骨软骨母细胞瘤,其中1例合并动脉瘤样骨囊肿并病理性骨折。术后患者伤口皆愈合良好,内固定稳定,随访期间关节活动度良好,行走负重无不适,无复发。结论髌骨软骨母细胞瘤的发生率极低,若合并动脉瘤样骨囊肿,则诊断难度增大,容易误诊,需要结合临床检查、影像学资料、病理学会诊等综合评估,治疗方法为打通、彻底刮除囊腔内病变肿瘤组织、电烧囊壁并充分植骨。

Objective To determine the clinical diagnosis,identification,and the treatment of the chondroblastoma in patella and conduct a review of the literature to further enhance the understanding and mastery of the disease.Methods We reported 3 cases of chondroblastoma in the patella,who were admitted to Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from July 2014 to January 2022 and were assessed by history taking,physical examination,X-ray,CT,or MRI scan.Clinical imaging suggested unicystic or multicystic expansive bone destruction in the patella.Patients were evaluated before surgery and afterwards underwent intralesional curettage,cauterization,and allogeneic/autogenous bone grafting.One patient had a pathologic fracture,in whom the fragments were reduced and fixed with Kirschner needles and wires.Results All patients were pathologically diagnosed as chondroblastoma in patella,one with aneurysmal bone cyst with pathologic fracture.The wounds healed well and internal fixation was stable.During follow-up,all patients had good joint activity and achieved full weight bearing without tumor recurrence postoperatively.Conclusion The chondroblastoma in patella is a rare tumor.If combined with aneurysmal bone cyst,the diagnosis might be easily misdiagnosed.The diagnosis is based on the clinical examination,imaging data,and the pathologic diagnosis.It can most often be adequately treated with thorough curettage intralesionally,intracapsular cauterization,and bone grafting adequately.