CAJ | 학술논문

目的：分析手部掌指骨的动脉瘤样骨囊肿的临床表现，影像学特点，鉴别诊断和治疗方法与复发率的关系。方法回顾2002年至2012年，我院手外科明确诊断的12例手部掌指骨的动脉瘤样骨囊病例的临床症状、体征，X线和MRI的影像学特点，术中大体特征及肿瘤性状表现，手术方法和植骨特点，手术后复发率等。结果12例中发生部位掌骨8例，指骨4例。年龄和性别无明确特点。临床症状以局部膨胀性改变(10例)和疼痛(6例)为主要特点。X线表现为膨胀性溶骨性病变，晚期可表现为皂泡样和吹气球样骨质破坏。MRI 可显示内部大小不一、信号强弱不等的囊腔和病灶内液平面。手术中可见骨皮质呈暗紫色，皮质膨胀变薄。手术采取高速磨钻刮除植骨(4例)，段截植骨(8例)等方式。术后复发1例。所有病例均经病理检查最后明确诊断。病理检查发现合并巨细胞瘤1例。结论手部掌指骨动脉瘤样骨囊肿临床罕见，临床表现特异性不强，易与其它肿瘤混淆，早期诊断常面临困难，根据病史特点和X线与MRI结合检查可明显提高诊断准确率，使用高速磨钻彻底刮除和瘤段切除植骨是防止复发的关键。
목적：분석수부장지골적동맥류양골낭종적림상표현，영상학특점，감별진단화치료방법여복발솔적관계。방법회고2002년지2012년，아원수외과명학진단적12례수부장지골적동맥류양골낭병례적림상증상、체정，X선화MRI적영상학특점，술중대체특정급종류성상표현，수술방법화식골특점，수술후복발솔등。결과12례중발생부위장골8례，지골4례。년령화성별무명학특점。림상증상이국부팽창성개변(10례)화동통(6례)위주요특점。X선표현위팽창성용골성병변，만기가표현위조포양화취기구양골질파배。MRI 가현시내부대소불일、신호강약불등적낭강화병조내액평면。수술중가견골피질정암자색，피질팽창변박。수술채취고속마찬괄제식골(4례)，단절식골(8례)등방식。술후복발1례。소유병례균경병리검사최후명학진단。병리검사발현합병거세포류1례。결론수부장지골동맥류양골낭종림상한견，림상표현특이성불강，역여기타종류혼효，조기진단상면림곤난，근거병사특점화X선여MRI결합검사가명현제고진단준학솔，사용고속마찬철저괄제화류단절제식골시방지복발적관건。
Objective To analyze the clinical features, imaging characteristics, differential diagnosis, clinical treatment methods and recurrence rate of aneurysmal bone cysts of the metacarpals and phalanges of the hand. Methods The clinical data of 12 patients with aneurysmal bone cysts of the metacarpals and phalanges of the hand who were adopted from 2002 to 2012 were retrospectively analyzed, including the clinical symptoms and signs, X-ray and Magnetic Resonance Imaging ( MRI ) features, intraoperative general characteristics, tumor performance, operative methods, bone graft and postoperative recurrence rate. Results Among the 12 cases, there were 8 cases in the metacarpal and 4 cases in the phalange. No deifnite characteristics existed referring to the age or gender. Local inlfation in 8 cases and pain in 6 cases were the main clinical features. The X-ray showed expansive lytic lesion, and soap-bubble-like and balloon-like bone destruction was noticed in the advanced stage. The MRI showed cyst cavities of various sizes and different signal intensities and intralesional lfuid-lfuid level. During the operation, the bone cortex became purple and thin and swelled. Curettage and bone grafting by a high-speed drill were performed on 4 patients, and resection and reconstruction on 8 patients. Postoperative recurrence was found in 1 case. The deifnitive diagnosis was made by the histopathological examination in all the patients. Combined giant cell tumors were noticed in 1 case. Conclusions Aneurysmal bone cysts of the metacarpals and phalanges of the hand is an infrequent disease, without speciifc clinical manifestations. It is very dififcult to make an early diagnosis, and it should be differentiated from other hand bone tumors. Based on the history characteristics and the X-ray and MRI examinations, the correct diagnosis ratio can be distinctly improved. The recurrence rate can be greatly reduced under the treatment of thorough curettage by a high-speed drill and resection and reconstruction.