Guyot-Drouot M H, Rouneau D, Rolland J M, Solau-Gervais E, Cotten A, Flipo R M, Duquesnoy B
Rheumatology Department, Roger Salengro Hospital, Lille, France.
Joint Bone Spine. 2000;67(2):94-100.
Arthritis, tenosynovitis, and bursitis due to sea urchin spine injuries have unique pathological features and run a chronic course until the spines are removed. Of the 40 cases of sea urchin spine-related clinical symptoms published to date, only 12 had osteoarticular symptoms.
We studied 12 cases with osteoarticular symptoms seen in Réunion Island from 1994 to 1998. There were nine cases of arthritis and one case each of tenosynovitis, fasciitis, and bursitis. The nine males and three females had an age range of 9 to 50 years.
The injury was at the knee in six cases, the foot in three, and the hand in three. The time from injury to lesion development ranged from two days to two and a half months. Laboratory tests were normal apart from evidence of mild inflammation in three of the arthritis cases. The spine was visible on plain radiographs in eight cases. Histology was done in seven patients and consistently showed a typical foreign body granuloma. Removal of the spine with synovectomy was performed in 11 cases and consistently ensured a full recovery.
The clinical manifestations and management in our patients were compared to those in earlier reports. The differential diagnosis of laboratory test, radiographic, and histologic findings is reviewed. Pathogenic hypotheses and the immunogenic effect of the protein sheath that surrounds sea urchin spines are discussed.
The diagnosis of these frequently under-recognized lesions rests on a careful history and on converging histologic, radiologic, and clinical findings.
海胆刺损伤导致的关节炎、腱鞘炎和滑囊炎具有独特的病理特征，在刺被取出之前病程呈慢性。在迄今已发表的40例与海胆刺相关临床症状的病例中，只有12例有关节骨症状。
我们研究了1994年至1998年在留尼汪岛见到的12例有关节骨症状的病例。其中有9例关节炎，1例腱鞘炎、1例筋膜炎和1例滑囊炎。9名男性和3名女性，年龄范围为9至50岁。
损伤部位在膝关节6例，足部3例，手部3例。从受伤到病变出现的时间为2天至2个半月。除3例关节炎病例有轻度炎症迹象外，实验室检查均正常。8例在X线平片上可见刺。7例患者进行了组织学检查，均显示典型的异物肉芽肿。11例进行了刺取出术并切除滑膜，均完全康复。
将我们患者的临床表现及治疗与早期报告中的情况进行了比较。对实验室检查、影像学及组织学检查结果的鉴别诊断进行了综述。讨论了致病假说以及围绕海胆刺的蛋白鞘的免疫原性作用。
这些常未被充分认识的病变的诊断依赖于仔细的病史以及组织学、影像学和临床检查结果的综合判断。
