Sakamoto Akio, Matsuda Shuichi
The Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Open Orthop J. 2017 May 17;11:397-403. doi: 10.2174/1874325001711010397. eCollection 2017.
Osteochondroma is a common benign bone tumor, protruding from the underlying normal bone. Osteochondromas can cause pain depending on their location and size. The pes anserinus is located at the proximal medial side of the tibia, where the tendinous insertions of the sartorius, gracilis and semitendinosus muscles collectively attach. Pes anserinus syndrome, or anserine bursitis, is a painful condition of the pes anserinus, and is more common in adults typically with overweight females. The occurrence of pes anserinus syndrome is rare in the paediatric population.
In the current case series, five patients with pes anserinus syndrome due to proximal tibial osteochondroma are reported. Pain was present in all cases, with snapping in one case. The average age of the patients was 13 ± 1.2 years, ranging from 12 to 15 years. Three patients had a single osteochondroma, and two patients had hereditary multiple exostoses. The sizes of the osteochondromas on plain radiographs varied from 0.5 to 2.5 cm, with an average of 1.46 ± 0.83 cm. All lesions characteristically were located at the medial-posterior edge of the proximal tibia. The symptoms resolved in four cases with surgical resection, and persisted in one non-resected patient.
The characteristic location of the osteochondroma causes pes anserinus syndrome, even though the lesion is small. The diagnosis of osteochondroma or pes anserinus syndrome may be overlooked when it occurs in a paediatric population. The symptoms seem to be consistent, and resection of the osteochondroma is necessary for treatment.
骨软骨瘤是一种常见的良性骨肿瘤，从下方的正常骨突出。骨软骨瘤可因其位置和大小而引起疼痛。鹅足位于胫骨近端内侧，是缝匠肌、股薄肌和半腱肌肌腱共同附着的部位。鹅足综合征，即鹅足滑囊炎，是一种鹅足部位的疼痛病症，在成年人中更为常见，通常见于超重女性。鹅足综合征在儿科人群中很少见。
在本病例系列中，报告了5例因胫骨近端骨软骨瘤导致鹅足综合征的患者。所有病例均有疼痛，其中1例有弹响。患者的平均年龄为13±1.2岁，年龄范围为12至15岁。3例患者有单发骨软骨瘤，2例患者有遗传性多发性骨软骨瘤。X线平片上骨软骨瘤的大小从0.5至2.5厘米不等，平均为1.46±0.83厘米。所有病变均特征性地位于胫骨近端的内侧后缘。4例患者经手术切除后症状缓解，1例未切除患者症状持续存在。
即使病变较小，骨软骨瘤的特征性位置也会导致鹅足综合征。当骨软骨瘤或鹅足综合征发生在儿科人群中时，其诊断可能会被忽视。症状似乎是一致的，切除骨软骨瘤是必要的治疗方法。
