Lee Dae-Hee, Jeong Woong-Kyo, Lee Soon-Hyuck
Department of Orthopaedic Surgery, Korea University School of Medicine, Anam hospital, Seoul, Korea.
J Pediatr Orthop. 2009 Sep;29(6):547-51. doi: 10.1097/BPO.0b013e3181b2b877.
The atypical presentation of intra-articular osteoid osteoma in the hip joint frequently results in delayed diagnosis compared with the diagnosis of extra-articular osteoid osteoma. We present 2 cases of hip joint osteoid osteoma in children treated by hip arthroscopy. Intra-articular osteoid osteoma was suspected when computed tomography (CT) findings were reviewed. Of the various surgical options including wide-open or CT-guided minimally invasive techniques, arthroscopic excision was selected for our patients to avoid damage to the adjacent growth plate (the triradiate cartilage) and to treat concomitant synovitis. Under arthroscopic visualization, biopsy specimens were obtained first, and the lesions were excised. In both cases, postoperative CT showed complete excision and histologic examination confirmed the diagnosis. Both patients enjoyed excellent clinical outcomes. We conclude that the arthroscopic excision of the hip joint osteoid osteoma in children is effective because it causes minimal damage to normal bone or the adjacent growth plate, and because synovectomy for concomitant synovitis may be performed. Hip arthroscopy also yields a biopsy specimen adequate for pathologic examination.
与关节外骨样骨瘤的诊断相比，髋关节内骨样骨瘤的非典型表现常常导致诊断延迟。我们报告2例儿童髋关节骨样骨瘤经髋关节镜治疗的病例。回顾计算机断层扫描（CT）结果时怀疑为关节内骨样骨瘤。在包括开放手术或CT引导下微创技术在内的各种手术选择中，为我们的患者选择了关节镜下切除，以避免损伤相邻的生长板（Y形软骨）并治疗伴发的滑膜炎。在关节镜直视下，首先获取活检标本，然后切除病变。在这两个病例中，术后CT显示病变完全切除，组织学检查确诊。两名患者均获得了优异的临床疗效。我们得出结论，儿童髋关节骨样骨瘤的关节镜下切除是有效的，因为它对正常骨骼或相邻生长板造成的损伤最小，并且可以对伴发的滑膜炎进行滑膜切除术。髋关节镜检查还能获取足够用于病理检查的活检标本。
