CAJ | 학술논문

目的探讨小儿局限骨化性肌炎的临床特点、诊断、治疗与预后,以期提高对本病的认识能力.方法回顾分析13例患儿临床资料及影像学特点,随访其治疗结果及预后情况.结果 13例患儿中,4例经病理活检确诊,包括3例因关节功能障碍或疼痛,作了骨化病灶切除术,其余9例结合临床及影像学的综合资料初步诊断并在随访观察中证实诊断,这9例主要临床特点为早期局部红肿热,后期包块伴局部关节活动受限,早期X线片无特殊发现,中后期可见高密度的由外向内呈带状、片、团状影与附近骨干并不相连;3例切除骨化块后2例完全康复,1例手指屈曲功能轻度受限,但较术前改善,1例39d患儿出院后死于其他病因,其余9例病变静止,多数有吸收趋势.结论本病是自限性疾病,但早期病变易与软组织感染、脓肿、骨髓炎或者恶性肿瘤等混淆,由于早中期影像学检查也多无特异性,诊断困难.局部无痛性红热肿块而无全身发热的特点,可能有助获得临床诊断并进一步随访确定诊断,合并全身发热、局部明显疼痛症状而又不能除外感染、恶性肿瘤者,仍需要及时进行活检手术,这仍然是获得正确治疗、避免误治的关键.
목적 탐토소인국한골화성기염적림상특점、진단、치료여예후,이기제고대본병적인식능력.방법 회고분석13례환인림상자료급영상학특점,수방기치료결과급예후정황.결과 13례환인중,4례경병리활검학진,포괄3례인관절공능장애혹동통,작료골화병조절제술,기여9례결합림상급영상학적종합자료초보진단병재수방관찰중증실진단,저9례주요림상특점위조기국부홍종열,후기포괴반국부관절활동수한,조기X선편무특수발현,중후기가견고밀도적유외향내정대상、편、단상영여부근골간병불상련;3례절제골화괴후2례완전강복,1례수지굴곡공능경도수한,단교술전개선,1례39d환인출원후사우기타병인,기여9례병변정지,다수유흡수추세.결론 본병시자한성질병,단조기병변역여연조직감염、농종、골수염혹자악성종류등혼효,유우조중기영상학검사야다무특이성,진단곤난.국부무통성홍열종괴이무전신발열적특점,가능유조획득림상진단병진일보수방학정진단,합병전신발열、국부명현동통증상이우불능제외감염、악성종류자,잉수요급시진행활검수술,저잉연시획득정학치료、피면오치적관건.
Objective To study the clinical features,diagnosis,treatment and prognosis of myositis ossificans circumscripta.Methods Clinical data of 13 children of myositis ossificans circumscripta were retrospectively analyzed.Results Four cases were diagnosed by pathological examination,including 3 cases who had resection of ossified mass because of joint dysfunction or pain.The other 9 cases were diagnosed according to clinical presentations and imaging features.The clinical presentations included redness,swelling,heat and tenderness.One case had no imaging abnormality at the early stage,but subsequently had typical X-ray features in mid and late stages.Two of the 3 cases who had resection recovered completely and one case had only very little impairment of finger flexion.During follow-up,eight of the 9 cases had stable disease,but one patient died of other unrelated cause.Conclusions Myositis ossificans circumscripta is a self-limiting disease,but it is often confused with other soft tissue conditions,such as abscess,osteomyelitis,or tumor at early stage.Clinical presentations may help to make a clinical diagnosis.Biopsy should be considered to avoid erroneous treatment.