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目的探讨腕骨外生骨软骨瘤的发病特点和影像学诊断方法。方法回顾性地分析了17例多发性骨软骨瘤的病例,其中9例在疾病的不同阶段均可见腕骨周围的异常钙化影。通过对这9例患者长期随访的影像学资料进行追踪对比、分析,总结腕骨外生骨软骨瘤的发病特点和影像学的诊断方法。结果本组病例观察到腕骨病变的年龄为3．5～8．0岁,平均[(5．7±1．6)岁,x±s,下同],有5例患者在10．0～15．0岁．平均(12．0±1．9)岁以后,在X线平片中就难以分辨骨软骨瘤的病变了,有3例患者在骨软骨瘤的X线影像与腕骨融合后仍可见腕骨显著的畸形。CT扫描有助于发现某些已经与腕骨融合的瘤体,MRI对腕骨外生骨软骨瘤的诊断并不比CT更敏感。腕骨的外生骨软骨瘤可以累及除豌豆骨外的所有腕骨,其中头状骨受累最为常见,瘤体可出现于一侧或双侧腕关节,受累侧的尺、桡骨和(或)掌、指骨也都有瘤体分布。在腕关节中,瘤体可同时累及两块腕骨,也可有多个瘤体累及一块腕骨。腕骨的瘤体极少影响腕关节的功能。结论腕骨外生骨软骨瘤在多发性骨软骨瘤的患者中较为常见,采用多体位X线平片在患儿的青少年时期较为容易发现异常病变影,CT扫描有助于定位并明确诊断,此类疾病多无需手术治疗。
Objective To investigate the pathogenesis and imaging diagnosis of exoskeleton osteochondroma of carpal bone. Methods The retrospective analysis of 17 cases of multiple osteochondromas showed abnormal calcification around the carpal bones in 9 different stages of the disease. The imaging features of the 9 cases of long-term follow-up were compared, analyzed, and the characteristics of the exoskeletal osteochondroma of the carpal bone and the imaging diagnostic methods were summarized. The results of this group of patients observed carpal lesions aged 3.5 to 8.0 years, mean [(5.7 ± 1.6) years, x ± s, the same below], 5 patients in 10.0 ~ 15.0 years old. After an average of (12.0±1.9) years of age, it was difficult to distinguish the lesions of osteochondroma in X-ray films. Three patients showed significant signs of carpal bones after the X-ray images of osteochondroma were combined with the carpal bones. deformity. The CT scan helps to find some tumors that have been fused with the carpal bones. MRI is not more sensitive than CT in the diagnosis of exoskeleton. Extracranial osteochondroma of carpal bone can involve all carpal bones other than pea bone. The most common is the involvement of the cranial bone. The tumor can occur on one or both wrist joints, with the affected foot, sacrum, and/or palm. Finger bones also have tumor distribution. In the wrist joint, the tumor body can involve two carpal bones at the same time, or there can be multiple tumors involving a carpal bone. The carpal tumor rarely affects the function of the wrist. Conclusion Exocarpal osteochondroma of the carpal bone is common in patients with multiple osteochondromas. The use of multi-position X-ray radiographs is more likely to detect abnormal lesions in adolescents. CT scans are helpful in locating and confirming the diagnosis. Many diseases do not require surgery.