Serigano Kenji, Ikeda Masayoshi, Nukaga Tadashi, Watanabe Masahiko
Head Physician, Department of Orthopaedic Surgery, Shonan Central Hospital, Fujisawa, Japan; Assistant Professor, Department of Orthopaedics, Tokai University School of Medicine, Isehara, Japan.
Director, Department of Orthopaedic Surgery, Shonan Central Hospital, Fujisawa, Japan; Associate Professor, Department of Orthopaedics, Tokai University School of Medicine, Isehara, Japan.
J Foot Ankle Surg. 2017 Nov-Dec;56(6):1328-1331. doi: 10.1053/j.jfas.2017.06.003. Epub 2017 Jul 29.
We encountered a rare case of a periosteal ganglion cyst at the plantar aspect of the metatarsal that induced a stress fracture in a 77-year-old female. The clinical manifestation of the plantar ganglion cyst of the foot was not evident because of its location deep beneath the plantar fascia. A pressure cortical indentation was detected at the metatarsal neck on the initial radiographs. Magnetic resonance imaging showed a stress fracture of the metatarsal with a ganglion cyst. The stress fracture was thought to have resulted from several factors, including structural weakness due to bony absorption from the ganglion cyst, osteoporosis that induced a fragility fracture, and a load-induced fatigue fracture. The fracture completely healed following complete resection of the ganglion cyst with the surrounding periosteum along with medication for osteoporosis. When confirmation of a stress fracture is necessary or when presentation of a stress fracture is atypical, magnetic resonance imaging should be considered to confirm or rule out any other associated pathologic features. Resection of the periosteal ganglion cyst with the surrounding periosteum is important to prevent recurrence.
我们遇到了一例罕见的病例，一名77岁女性的跖骨足底侧出现骨膜囊肿，引发了应力性骨折。由于足部足底囊肿位于足底筋膜深层，其临床表现并不明显。初次X线片显示跖骨颈部有压力性皮质凹陷。磁共振成像显示跖骨应力性骨折合并神经节囊肿。应力性骨折被认为是由多种因素导致的，包括神经节囊肿引起的骨质吸收导致的结构薄弱、诱发脆性骨折的骨质疏松以及负荷诱导的疲劳骨折。在完整切除神经节囊肿及其周围骨膜并进行骨质疏松药物治疗后，骨折完全愈合。当需要确认应力性骨折或应力性骨折表现不典型时，应考虑进行磁共振成像以确认或排除任何其他相关的病理特征。切除骨膜囊肿及其周围骨膜对于预防复发很重要。
