Instructor, Podiatry Section Research Director, Orthopaedic Surgery Wake Forest Baptist Medical Center, Winston-Salem, NC.
Section Chief, Orthopaedic Surgery, Associate Professor Orthopaedic Surgery Wake Forest Baptist Medical Center, Winston-Salem, NC.
J Foot Ankle Surg. 2021 May-Jun;60(3):609-614. doi: 10.1053/j.jfas.2020.09.002. Epub 2020 Sep 8.
Aneurysmal bone cysts (ABCs) are rare in the foot, accounting for 4% to 6.3% of all ABCs found in the body. Approximately 80% of patients diagnosed with an ABC are in the second decade of life. While benign, pain and deformity are often the presenting symptoms. This report's objective is to describe, to our knowledge, the first reported case of a pediatric navicular ABC in association with pediatric flatfoot deformity that was successfully treated with curettage and bone grafting. An additional goal of the report is to highlight how the diagnosis of these osseous tumors can easily be missed given the overlap in symptoms with pediatric flatfoot deformity. An 11-year-old female presented to clinic with a chief complaint of painful, flatfoot deformity and discomfort to the medial midfoot after walking for more than 2 city blocks. The patient was conservatively treated for pediatric flatfoot deformity at an outside institution and advised that a surgical flatfoot reconstruction would be necessary to relieve her symptomology. On examination, the patient exhibited focal pain to the medial aspect of the navicular. Radiographs revealed an ill-defined, expansile, sclerotic lesion of the navicular, and MRI demonstrated a multicystic lesion filling the navicular, consistent with an ABC. Treatment included curettage and packing with allograft. At 1-year follow-up, the patient is well, with minimal pain and return to full activity without functional limitations. Local recurrence of an aneurysmal bone cyst following curettage and bone grafting is as high as 22% with patient age and lesion size comprising the main risk factors. This report demonstrates successful curettage of an ABC within the navicular and preservation of osseous articulations in a pediatric patient. At 1-year follow-up, the patient had minimal pain with no evidence of recurrence.
骨巨细胞瘤（ABC）在足部较为罕见，占全身所有 ABC 的 4%至 6.3%。约 80%诊断为 ABC 的患者处于生命的第二个十年。虽然良性，但疼痛和畸形通常是其主要表现症状。本报告的目的是描述我们所知道的首例儿童舟骨 ABC 与儿童扁平足畸形相关的病例，该病例通过刮除和植骨成功治疗。本报告的另一个目的是强调这些骨肿瘤的诊断很容易被忽视，因为其症状与儿童扁平足畸形有重叠。一名 11 岁女性因行走超过 2 个街区后出现中足内侧疼痛、扁平足畸形和不适的主诉就诊于诊所。该患者在一家外部机构接受了儿童扁平足畸形的保守治疗，并被告知需要进行手术平足重建以缓解其症状。体格检查时，患者表现出舟骨内侧的局灶性疼痛。X 线片显示舟骨有一个定义不明确、膨胀性、硬化性病变，MRI 显示一个多房囊性病变填充舟骨，符合 ABC 的表现。治疗包括刮除和同种异体骨移植填充。1 年随访时，患者情况良好，疼痛轻微，恢复到完全活动状态，无功能受限。刮除和植骨后 ABC 的局部复发率高达 22%，患者年龄和病变大小是主要的危险因素。本报告显示，在儿童患者中成功地对舟骨内的 ABC 进行了刮除，并保留了骨关节。1 年随访时，患者疼痛轻微，无复发迹象。
