Gharahdaghi Mohammad, Rahimi Shorin Hassan, Parsa Ali, Assadian Maryam
Department of Orthopedic Surgery, Mashhad University of Medical Sciences, Mashhad, IR Iran.
Department of Orthopedic Surgery, Zahedan University of Medical Sciences, Zahedan, IR Iran.
Iran Red Crescent Med J. 2013 Nov;15(11):e9534. doi: 10.5812/ircmj.9534. Epub 2013 Nov 5.
Osteoid osteomas account for approximately 2- 3% of all primary bone neoplasm's sampled for biopsy. 50% of all of them occur in the long bones of the lower extremities, but osteoid osteoma of the coracoid process is rare. We have found only nine previously reported cases of coracoid osteoid osteoma in the international literature. We report a child with coracoid base osteoid osteoma.
A twelve-years-old boy with a persistent pain at the right shoulder since 9 months ago, were evaluated. His pain relatively responds to non-steroidal anti-inflammatory drugs (NSAIDs). Imaging studies showed foci of sclerosis at right coracoid base with increased uptake on the Technetium-99m study. Because proximity to the neurovascular bundle we couldn't use radiofrequency ablation technique, so the patient underwent open surgery with a mini- deltopectoral approach and two level osteotomies ; one proximal to coracoid tip and the other at the base of coracoid just distal to subcoracoidphyseal line. Then a segment of coracoid resected. Tip of coracoid securely reattached with a screw.
To our knowledge in the literature up to now there are only nine reports of coracoid osteoid osteoma. These cases were treated with different approaches and different techniques. We used en-bloc resection via mini-anterior approach. Our patient 30 months after surgery (October 2012) have full range of motion and became pain free since wound healing with normal control imaging.Definite diagnosis of osteoid osteoma in the uncommon sites may be delayed. En bloc resection of tumor with two osteotomies by an anterior approach has been limited soft tissue injury and is a reliable method of treatment.
骨样骨瘤约占所有接受活检的原发性骨肿瘤的2% - 3%。其中50%发生在下肢长骨，但喙突骨样骨瘤罕见。我们在国际文献中仅发现9例先前报道的喙突骨样骨瘤病例。我们报告1例喙突基底骨样骨瘤患儿。
一名12岁男孩，自9个月前起右肩部持续疼痛，接受评估。其疼痛对非甾体类抗炎药（NSAIDs）有一定反应。影像学检查显示右喙突基底有硬化灶，锝-99m检查示摄取增加。由于靠近神经血管束，我们无法使用射频消融技术，因此患者采用经胸小肌前入路行开放手术及两级截骨术；一级在喙突尖近端，另一级在喙突基底、喙突下骨骺线远侧。然后切除一段喙突。用螺钉将喙突尖牢固重新固定。
据我们所知，迄今为止文献中仅有9例喙突骨样骨瘤的报道。这些病例采用了不同的方法和技术进行治疗。我们采用经前入路整块切除。我们的患者在手术后30个月（2012年10月）活动范围正常，伤口愈合后疼痛消失，影像学检查正常。在不常见部位的骨样骨瘤的明确诊断可能会延迟。经前入路行两级截骨整块切除肿瘤，软组织损伤有限，是一种可靠的治疗方法。
