胫骨髓内骨硬化是一种罕见的疾病,其特征是由于骨干骨增生引起的慢性疼痛,没有可检测的触发因素。主要的鉴别诊断是应力性骨折和骨样骨瘤。在迄今为止报告的少数病例中,大多数是成年人。这项研究的目的是评估患有髓内骨硬化的儿科患者,以确定首次就诊是否提供了足够的信息来确定诊断并排除骨样骨瘤和应力性骨折。是否需要活检,以及哪种治疗方法是最佳的。
胫骨髓内骨硬化的诊断可以在第一次就诊时进行。
7名儿科患者,4男3女,平均年龄为11岁,纳入本回顾性研究。我们评估了临床特征,影像学研究的结果(标准射线照片,计算机断层扫描,磁共振成像,和骨闪烁显像),和治疗结果。
第一次访问时,所有患者胫骨中部疼痛性肿胀,影像学研究证据表明胫骨前外侧皮质增厚延伸到髓腔;在5例患者中,可见线性透明度。未见其他骨异常。治疗包括非手术措施,钉扎,和钉子。这些治疗都不能提供永久的骨骼愈合或疼痛缓解,尽管在有或没有放射学骨愈合的情况下实现了短暂的疼痛自由。
胫骨髓内骨硬化很少报道,因此可能未被诊断。皮质和骨内膜增厚的独特特征包括位于前外侧中骨干的位置,在某些情况下,同时存在可以提供早期诊断的线性透明度。独特的放射学特征允许与应力断裂区分开。管理具有挑战性。
IV,回顾性观察性研究。
Intra-medullary osteosclerosis of the tibia is a rare condition characterised by chronic pain due to diaphyseal hyperostosis with no detectable triggering factor. The main differential diagnoses are stress fracture and osteoid osteoma. Of the few cases reported to date, most were in adults. The objective of this study was to assess paediatric patients with intra-medullary osteosclerosis to determine whether the first visit provides sufficient information to establish the diagnosis and rule out both osteoid osteoma and stress fracture, whether a biopsy is required, and which treatment is optimal.
The diagnosis of intra-medullary osteosclerosis of the tibia can be made at the first visit.
Seven paediatric patients, 4 males and 3 females, with a mean age of 11 years, were included in this retrospective study. We evaluated the clinical features, findings from imaging studies (standard radiographs, computed tomography, magnetic resonance imaging, and bone scintigraphy), and treatment outcomes.
At the first visit, all patients had a painful swelling at the middle of the shin and imaging study evidence of antero-lateral tibial cortical thickening extending into the medullary cavity; in 5 patients, a linear lucency was visible. No other bone abnormalities were seen. Treatments included non-operative measures, pinning, and nailing. None of these treatments provided permanent bone healing or pain relief, although transitory freedom from pain with or without radiological bone healing was achieved.
Intra-medullary osteosclerosis of the tibia is rarely reported and therefore probably underdiagnosed. Distinctive characteristics of the cortical and endosteal thickening include location at the antero-lateral mid-diaphysis and, in some cases, the concomitant presence of a linear lucency that can provide the early diagnosis. The distinctive radiological features allow differentiation from a stress fracture. The management is challenging.
IV, retrospective observational study.