摘要
目的探讨指骨表皮样囊肿的诊断及治疗方法,从而提高对该疾病的认识,降低误诊率,并为规范治疗提供借鉴。方法对2006年9月至2016年11月收治的8例指骨表皮样囊肿病例进行回顾性分析,并详细复习同疾病相关文献。从该病的病因、病史、临床表现、影像学特征、误诊概率、处置方法等方面进行分析。总结该疾病的病史、临床、影像表现等诊断学特征,并评估不同处置方法的远期治疗效果。结果该组病人病史均较长,发病至就诊0.5~30年,平均12.3年;回顾病程,本组8例病人中,有明确外伤史的7例,1例不能明确局部外伤,且为10岁儿童,或为胚胎遗留上皮发展所致;该组病人发病部位均位于末节指骨,其中拇指2例,食指2例,中指3例,小指1例;特征性体征表现:病患指节体部逐渐增粗,呈膨胀性,指甲呈球形凸起,手指末稍血运良好,皮肤感觉无异常,用力或局部压迫时有疼痛不适;影像学特点:与指骨长轴一致的圆形或椭圆形、边界清楚的溶骨样破坏,伴有周围皮质骨的膨胀变薄或病理性骨折;不同医疗机构临床误诊次数:2~5次不等,平均3.5次,我单位临床误诊6例,误诊率75%。处理及预后:8例中,3例采取了截指手术,2例采取单纯刮除手术,3例采用刮除并髂骨植骨术,切口均一期愈合。术后随访12~60个月,平均28.8个月,除1例截指病人并发1年残端痛外均预后良好。保留手指外形改善,无复发病例。结论指骨表皮样囊肿是一种发病率很低,且临床误诊率较高的疾病;仔细分析患者病史、临床表现、影像学特征可提高该病的临床诊断阳性率;根据病情的严重程度,采用'单纯刮除'或'刮除+植骨'是治疗该病的合理、有效方法。
Objective To investigate the diagnosis and treatment of phalangeal epidermoid cysts,so as to improve the understanding of the disease,reduce the rate of misdiagnosis and provide reference for its normative treatment.Methods Eight cases of phalangeal epidermoid cysts patients from September 2006 to November 2016 were retrospectively reviewed,and literature that focus on the disease were carefully reviewed.The etiology,medical history,clinical manifestations,imaging features,misdiagnosis rate,and disposal methods of the disease were analyzed.To summarize the diagnostic characteristics of the disease,such as medical history,clinical and imaging findings etc,and to evaluate the long-term therapeutic effects of different methods.Results This group of patients had a long medical history,ranging from 0.5 to 30 years from onset to treatment,with an average of 12.3 years.Review the course of disease among the 8 patients,there were 7 cases with a clear history of trauma,and 1 case could not clear.It was a 10-year-old child,and maybe caused by the development of epithelial cells left in the embryo;The incidence of this group of patients are located in the distal phalanx,including 2 thumb,2 index finger,3 middle finger,1 little finger;Characteristic signs:The body of the knuckle is gradually thickened,expansive,the nail is spherically convex,the blood supply is good at the end of the finger,the skin feels no abnormality,and has pain when forced or partial compression.The imaging features:Circular or elliptical shape consistent with the long axes of the phalanx,clear bone-like destruction of the boundary,expansion and thinning or pathological fracture of the surrounding cortical bone;Clinical misdiagnosis by different medical institutions:2-5 times,an average of 3.5 times.6 cases were misdiagnosed in our hospital,and the rate of misdiagnosis was 75%.Treatment and prognosis:In the 8 patients,3 underwent amputation of finger-surgery,2 underwent simple curettage,and 3 underwent scraping and iliac bone grafting,the incisions were
作者
施洪臣
杨洋
王世杰
连运通
李振举
章雪松
梁文素
祝青松
SHI Hong-chen;YANG Yang;WANG Shi-jie;LIAN Yun-tong;LI Zhen-ju;ZHANG Xue-song;LIANG Wen-su;ZHU Qing-song(Department of Hand Surgery(Former Hand Surgery Clinical Research Center of Beijing Military Region),the No.980 Hospital Handan District,Handan 056001,China;不详)
出处
《中国误诊学杂志》
CAS
2019年第3期106-109,共4页
Chinese Journal of Misdiagnostics
关键词
指骨表皮样囊肿
误诊
刮除
植骨
phalange epidermoid cyst
misdiagnosis
scraping
bone graft
