Ikeda M, Oka Y
Department of Orthopaedic Surgery, Tokai University Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-gun, Kanagawa, 259-0198, Japan.
Hand Surg. 2000 Jul;5(1):25-32. doi: 10.1142/s021881040000003x.
Six cases of symptomatic cystic lesions of carpal bones which underwent operative treatment were reviewed. Definite diagnosis, etiology and treatment were also discussed. The lesions occurred in the scaphoid, lunate, capitate and triquetrum, and were multiple lesions in four of the six cases. Juxta-articular bone cyst was diagnosed in three cases: intraosseous cavity surrounded by fibrous membrane containing gelatinous material, and "bone cyst-like pathologic change" in three cases which contained fibrous connective tissue resembled the thick inner wall of juxta-articular bone cyst histologically. They were treated by curettage and cancellous bone grafting; the outcomes were favourable without complication. It is suggested that the minor trauma resulting from the carpal loading serves as a basis for intraosseous lesion, which initiates intramedullary metaplasia followed by fibrous connective tissue proliferation with/without mucin secretion, and forms cystic cavity.
回顾了6例接受手术治疗的腕骨有症状性囊性病变的病例。还讨论了明确的诊断、病因和治疗方法。病变发生在舟骨、月骨、头状骨和三角骨,6例中有4例为多发病变。3例诊断为关节旁骨囊肿:骨内腔被含有凝胶状物质的纤维膜包围,3例为“骨囊肿样病理改变”,其组织学上含有类似关节旁骨囊肿厚内壁的纤维结缔组织。对其进行了刮除和松质骨移植治疗;结果良好,无并发症。提示腕部负荷引起的轻微创伤是骨内病变的基础,引发骨髓化生,随后纤维结缔组织增殖伴或不伴粘蛋白分泌,形成囊性腔隙。