Ruales Romero A M, Doiz Artazcoz E, Craven-Bartle Coll A, Gonzalez Calbo A, Rodríguez Piñero M
Hospital Universitario Puerta del Mar, Cadiz, Andalucía, Spain.
EJVES Short Rep. 2016 Oct 17;33:27-31. doi: 10.1016/j.ejvssr.2016.09.004. eCollection 2016.
Osteochondroma is the most common non-malignant tumour of bone, accounting for approximately one third of benign lesions in the skeleton. They often develop around the knee in the distal femur and in the proximal tibia and fibula. They present as a painless slow growing mass during adolescence and have been reported to cause damage to adjacent structures such as blood vessels; arterial damage is more common than venous injury and is usually a result of compression, stretching, and rubbing of the arterial wall. Such lesions include stenosis, thrombosis, and pseudoaneurysm formation possibly causing lower limb claudication or acute limb ischemia.
An 18 year old male patient with a 4 week history of pain, hematoma, and oedema of the left calf without previous trauma is reported. A computed tomography scan (CT) revealed a large popliteal artery pseudoaneurysm and its close relationship to a protrusion of the proximal tibia.
The popliteal artery was repaired by an external saphenous patch and the exostosis was removed. The patient had palpable popliteal and distal pulses after surgery and during the first year follow-up.
Tibial osteochondroma should be considered in the differential diagnosis in young patients, among the potential causes of pseudoaneurysm of the femoral or popliteal artery. Surgical repair should be performed to restore normal blood flow with resection of the exostosis to prevent recurrence.
骨软骨瘤是最常见的非恶性骨肿瘤，约占骨骼良性病变的三分之一。它们常发生于股骨远端、胫骨近端和腓骨近端的膝关节周围。在青少年时期，它们表现为无痛性缓慢生长的肿块，据报道可对相邻结构如血管造成损害；动脉损伤比静脉损伤更常见，通常是动脉壁受压、拉伸和摩擦的结果。此类病变包括狭窄、血栓形成和假性动脉瘤形成，可能导致下肢跛行或急性肢体缺血。
报告一例18岁男性患者，左小腿疼痛、血肿和水肿4周，既往无外伤史。计算机断层扫描（CT）显示一个巨大的腘动脉假性动脉瘤及其与胫骨近端突出部的密切关系。
采用大隐静脉补片修复腘动脉，并切除外生骨疣。术后及第一年随访期间，患者腘动脉和远端脉搏可触及。
在年轻患者中，股骨或腘动脉假性动脉瘤的潜在病因鉴别诊断中应考虑胫骨骨软骨瘤。应进行手术修复以恢复正常血流，并切除外生骨疣以防止复发。
