Gao Zhipeng,Ju Li,Xu Mengqiu,et al.Clinical manifestations and imaging features of pubic bone lesions in children[J].Journal of Clinical Pediatric Surgery,2023,22(06):563-568.[doi:10.3760/cma.j.cn101785-202011041-013]
儿童耻骨骨病变的临床表现及影像学特征分析
- Title:
- Clinical manifestations and imaging features of pubic bone lesions in children
- Keywords:
- Pubic Bone; Bone Diseases; Physiopathology; Treatment Outcome; Child
- 摘要:
- 目的 初步探讨儿童耻骨骨病变的临床表现以及影像学特征，以提高儿童耻骨骨病变的临床诊断水平。方法 回顾性分析2009年1月至2020年5月于南京医科大学附属儿童医院骨科经手术及病理检查确诊的10例耻骨骨病变患儿临床资料，收集患儿临床表现、病种分布及影像学特征进行分析。结果 10例患儿中男、女各5例；病变累及左、右侧耻骨各5例；年龄4岁4个月至15岁（平均年龄10岁7个月）。初诊时表现为腹股沟疼痛伴跛行8例，腹股沟疼痛伴发热1例，体检摄片发现1例。8例行X线检查，10例行CT检查（其中7例同时行MRI检查）。术后病理结果：朗格汉斯细胞组织细胞增生症4例，纤维结构不良2例，慢性骨髓炎、骨结核、骨软骨瘤及单纯性骨囊肿各1例。结论 儿童耻骨骨病变临床少见，病变类型及影像学表现多样；单纯依靠临床表现和影像学检查诊断较为困难，确诊需依赖病理检查，病理上多为良性病变，恶性病变少见；手术治疗通常能获得较好效果。
- Abstract:
- Objective To explore the disease distribution and imaging features of pubic lesions in children.Methods From January 2009 to May 2020, a total of 10 pathologically confirmed children with pubic bone lesions were retrospectively reviewed.Clinical manifestations, disease distribution and imaging features were analyzed.Results There were 5 boys and 5 girls with an average treatment age of 10.7(4.3-12.58) years.The involved side was left (n=5) and right (n=5).Chief complaints included groin pain & limping (n=8) and groin pain & fever (n=1).The relevant examinations included radiology (n=8), computed tomography (CT, n=10) and magnetic resonance imaging (MRI, n=7).The pathological diagnosis was Langerhans cell histiocytosis (n=4), fibrous dysplasia (n=2), chronic osteomyelitis (n=1), basal tuberculosis (n=1), simple bone cyst (n=1) and osteochondroma (n=1).Conclusion Pubic bone lesions are rare in children.Great varieties of pubic bone lesions exist in children and their imaging features are characteristic.It is rather difficult to make a definite diagnosis solely on the basis of clinical and imaging features and surgery often yield better outcomes.Most lesions are benign and operations have a decent prognosis without any obvious sequel.
参考文献/References:
[1] 苗其云, 赵振金.耻骨滑膜肉瘤超声表现1例[J].中华超声影像学杂志, 2002, 11(6):352.DOI:10.3760/j.issn:1004-4477.2002.06.026. Miao QY, Zhao ZJ.Ultrasonographic features of synovial pubic sarcoma:one case report[J].Chin J Ultrasonogr, 2002, 11(6):352.DOI:10.3760/j.issn:1004-4477.2002.06.026.
[2] Nayak A, Kulkarni S, Kulkarni A, et al.Aneurysmal bone cyst of the pubis:a case report[J].J Clin Diagn Res, 2013, 7(8):1740-1742.DOI:10.7860/JCDR/2013/5514.3254.
[3] Nystrom LM, DeYoung BR, Morcuende JA.Secondary chondrosarcoma of the pelvis arising from a solitary exostosis in an 11-year-old patient:a case report with 5-year follow-up[J].Iowa Orthop J, 2013, 33:213-216.
[4] 于宝海.骨肿瘤与肿瘤样病变发病情况的临床分析[D].石家庄:河北医科大学, 2011. Yu BH.Clinical analysis of the incidence of bone tumors and tumor-like lesions[D].Shijiazhuang:Hebei Medical University, 2011.
[5] Hammoud S, Weber K, McCarthy EF.Unicameral bone cysts of the pelvis:a study of 16 cases[J].Iowa Orthop J, 2005, 25:69-74.
[6] Dimitrakopoulou A, Schilders E.Current concepts of inguinal-related and adductor-related groin pain[J].Hip Int, 2016, 26(Suppl 1):2-7.DOI:10.5301/hipint.5000403.
[7] 王洪平, 兰玉平.耻骨骨髓炎伴随高热1例并文献复习[J].中国伤残医学, 2017, 25(11):77-79.DOI:10.13214/j.cnki.cjotadm.2017.11.045. Wang HP, Lan YP.Symphysis pubic osteomyelitis with high fever:a case report with a literature review[J].Chin J Trauma Disabil Med, 2017, 25(11):77-79.DOI:10.13214/j.cnki.cjotadm.2017.11.045.
[8] Broadley P, Offiah AC.Hip and groin pain in the child athlete[J].Semin Musculoskelet Radiol, 2014, 18(5):478-488.DOI:10.1055/s-0034-1389265.
[9] Dapunt U, Mischnik A, Goeppinger S, et al.A persistent case of tuberculosis of the pubic symphysis and pubic bone[J].BMJ Case Rep, 2014, 2014:bcr2013203456.DOI:10.1136/bcr-2013-203456.
[10] Schillaci O, Scimeca M, Toschi N, et al.Combining diagnostic imaging and pathology for improving diagnosis and prognosis of cancer[J].Contrast Media Mol Imaging, 2019, 2019:9429761.DOI:10.1155/2019/9429761.
[11] 唐浩, 邹丹凤, 陈丽君, 等.耻骨肿瘤及肿瘤样病变影像学表现[J].广东医学, 2011, 32(3):331-333.DOI:10.3969/j.issn.1001-9448.2011.03.023. Tang H, Zou DF, Chen LJ, et al.Imaging findings of tumors and tumor-like pubic lesions[J].Guangdong Med J, 2011, 32(3):331-333.DOI:10.3969/j.issn.1001-9448.2011.03.023.
[12] 胡振彬, 陈卫国, 秦耿耿, 等.耻骨原发性肿瘤及肿瘤样病变的影像学诊断[J].实用医学杂志, 2016, 32(1):101-104.DOI:10.3969/j.issn.1006-5725.2016.01.031. Hu ZB, Chen WG, Qin GG, et al.Imaging diagnosis of primary tumors and tumor-like lesions of pubis[J].J Pract Med, 2016, 32(1):101-104.DOI:10.3969/j.issn.1006-5725.2016.01.031.
[13] 郑洪波.耻骨原发性肿瘤及肿瘤样病变的影像学表现及诊断价值[J].医学理论与实践, 2018, 31(11):1671-1673.DOI:10.19381/j.issn.1001-7585.2018.11.058. Zheng HB.Imaging features and diagnostic values of primary tumors and tumor-like pubic lesions[J].J Med Theory Pract, 2018, 31(11):1671-1673.DOI:10.19381/j.issn.1001-7585.2018.11.058.
[14] 臧杰, 郭卫, 汤小东, 等.人工韧带在耻骨肿瘤切除后重建下腹壁缺损中的应用[J].北京大学学报(医学版), 2018, 50(6):1049-1052.DOI:10.19723/j.issn.1671-167X.2018.06.019. Zang J, Guo W, Tang XD, et al.Application of artificial ligament in treatment of lower abdominal wall reconstruction after pubic tumor resection[J].J Peking Univ (Health Science Edition), 2018, 50(6):1049-1052.DOI:10.19723/j.issn.1671-167X.2018.06.019.
[15] ?ztürk R, Ulucak?y C, Atalay ?B, et al.Management and retrospective analysis of pelvic ramus tumors and tumor-like lesions:evaluation with 31 cases[J].Jt Dis Relat Surg, 2020, 31(2):184-192.DOI:10.5606/ehc.2020.72762.
[16] Higuchi T, Yamamoto N, Shirai T, et al.Treatment outcomes of the simple bone cyst:a comparative study of 2 surgical techniques using artificial bone substitutes[J].Medicine (Baltimore), 2018, 97(18):e0572.DOI:10.1097/MD.0000000000010572.
[17] 赫荣国.儿童骨肿瘤诊断与治疗的进展(一)骨肿瘤[J].临床小儿外科杂志, 2004, 3(1):55-57.DOI:10.3969/j.issn.1671-6353.2004.01.018. He RG.Progress in diagnosis and treatment of bone tumor in children[J].J Clin Ped Sur, 2004, 3(1):55-57.DOI:10.3969/j.issn.1671-6353.2004.01.018.
[18] 唐浩, 邹丹凤, 陈卫国, 等.骨盆嗜酸性肉芽肿影像诊断及误诊分析[J].南方医科大学学报, 2010, 30(10):2354-2356.DOI:10.12122/j.issn.1673-4254.2010.10.038. Tang H, Zou DF, Chen WG, et al.Imaging diagnosis of pelvic eosinophilic granuloma and analyses of the misdiagnoses[J].J South Med Univ, 2010, 30(10):2354-2356.DOI:10.12122/j.issn.1673-4254.2010.10.038.
[19] 孙祥水, 王晓东.儿童骨盆骨质破坏的病种分布及影像学表现[J].中华小儿外科杂志, 2020, 41(1):75-82.DOI:10.3760/cma.j.issn.0253-3006.2020.01.016. Sun XS, Wang XD.Distribution and imaging features of pelvic bone destruction in children[J].Chin J Pediatr Surg, 2020, 41(1):75-82.DOI:10.3760/cma.j.issn.0253-3006.2020.01.016.
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备注/Memo
收稿日期:2020-11-24。
通讯作者:林刚,Email:njchlg@126.com