Sagtas Ergin, Gokkus Kemal, Aydin Ahmet Turan
Department of Radiology, Memorial Antalya Hospital, Zafer Mah. Yildirim Beyazit Cad. No. 91, Kepez, Antalya, Turkey.
Department of Orthopedic Surgery and Trauma, Memorial Antalya Hospital, Zafer Mah. Yildirim Beyazit Cad. No. 91, Kepez, Antalya, Turkey.
Case Rep Orthop. 2017;2017:5846368. doi: 10.1155/2017/5846368. Epub 2017 May 2.
A 32-year-old male patient presented to our clinic with chronic left knee pain that was ongoing for about 1.5 years. The patient visited several times our clinic and the other clinics; conservative treatment (including rest, knee brace, and ice application with NSAIDs) was recommended by various different doctors. The anamnesis, physical examination, and plain radiography were nonspecific. Early MRI findings mislead us to believe it is bone marrow edema. One and half years with noneffective treatment, the knee pain persisted. At the latest visit intra-articular osteoid osteoma was suspected and the knee MRI with CT was employed. Even though the diagnosis of intra-articular osteoid osteoma often presents a challenge for the surgeons, with a present awareness of intra-articular osteoid osteomas which lack the characteristic sclerotic lesions and nidus on plain X-rays and the aid of multislice CT, a correct diagnosis which warrants proper treatment can be achieved. The possibility of osteoid osteomas, especially in young adults with persistent knee pain with unknown reasons that show normal plain radiographs results, must not be overlooked. The treatment method of these lesions should be customized depending on the location of the lesion, experience of the surgeon, and cost of method.
一名32岁男性患者因左膝关节慢性疼痛前来我院就诊,该疼痛持续约1.5年。患者曾多次来我院及其他诊所就诊;不同医生均建议采取保守治疗(包括休息、佩戴膝关节支具以及使用非甾体抗炎药并冰敷)。病史、体格检查及X线平片均无特异性。早期MRI检查结果误导我们认为是骨髓水肿。经过1.5年的无效治疗,膝关节疼痛依然持续。在最近一次就诊时,怀疑为关节内骨样骨瘤,并进行了膝关节MRI及CT检查。尽管关节内骨样骨瘤的诊断对外科医生来说常常是一项挑战,但鉴于目前对关节内骨样骨瘤的认识,即在X线平片上缺乏特征性硬化性病变和瘤巢,借助多层螺旋CT,仍可做出正确诊断并进行恰当治疗。骨样骨瘤的可能性,尤其是在原因不明的持续性膝关节疼痛且X线平片结果正常的年轻成年人中,绝不能被忽视。这些病变的治疗方法应根据病变位置、外科医生的经验以及治疗方法的成本进行定制。