Dutt Laksha, Schade Valerie L, Manoso Mark W
Postgraduate Year 2 Resident, Podiatric Medicine Surgical Residency, Madigan Army Medical Center, Tacoma, WA.
Chief, Limb Preservation Service, Madigan Army Medical Center, Tacoma, WA.
J Foot Ankle Surg. 2015 Mar-Apr;54(2):258-67. doi: 10.1053/j.jfas.2014.12.006. Epub 2015 Jan 23.
Chondroblastomas account for <2% of all bone tumors. The calcaneus is the fifth most common location of occurrence. Males in their second decade of life are most often affected, presenting with an insidious onset of localized pain, swelling, and tenderness. The finding of associated pathologic fracture has been rare. Imaging studies can aid in the formulation of the differential diagnosis and surgical plan. The definitive diagnosis requires histologic examination. Curettage and bone grafting is curative in >80% of cases. Local recurrence rates of ≤38% have been reported, most often because of inadequate resection, and have been associated with malignant conversion and metastasis. Adjuvant therapies can help minimize the incidence of local recurrence. Long-term follow-up examinations are recommended, given the protracted interval that can exist between recurrence and the potential for malignant conversion and metastasis. We present the case of a young, healthy, active male with a calcaneal chondroblastoma and associated pathologic fracture whose initial treatment consisted of curettage, hydrogen peroxide lavage, and allogeneic bone grafting. Recurrence developed at 15 months postoperatively and was treated with repeat curettage, high-speed burring, and reconstruction with steel Steinman pins and polymethylmethacrylate, resulting in no pain or recurrence at the 5-month follow-up point.
软骨母细胞瘤占所有骨肿瘤的比例不到2%。跟骨是其第五大常见发病部位。最常受累的是20岁左右的男性,表现为局部疼痛、肿胀和压痛起病隐匿。合并病理性骨折的情况罕见。影像学检查有助于制定鉴别诊断和手术方案。确诊需要组织学检查。刮除术和植骨术在80%以上的病例中可治愈。据报道,局部复发率≤38%,最常见的原因是切除不彻底,且与恶性转化和转移有关。辅助治疗有助于降低局部复发的发生率。鉴于复发与恶性转化及转移可能性之间可能存在较长间隔,建议进行长期随访检查。我们报告一例年轻、健康、活跃的男性跟骨软骨母细胞瘤合并病理性骨折病例,其初始治疗包括刮除术、过氧化氢冲洗和同种异体骨移植。术后15个月复发,再次行刮除术、高速磨钻处理,并采用斯氏针和聚甲基丙烯酸甲酯重建,术后5个月随访时无疼痛且未复发。