Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Orthopaedics, University Hospitals Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio.
J Bone Joint Surg Am. 2021 Apr 7;103(7):575-580. doi: 10.2106/JBJS.20.00999.
Benign bone tumors are common incidental findings in the pediatric population during radiographic evaluation. Counseling these patients requires reassurance and raises questions about the natural history of these tumors over time. The purpose of this study was to estimate the prevalence and observe the behavior of benign childhood bone tumors in an asymptomatic population.
A historical, longitudinal radiographic collection of healthy children was reviewed, which included comprehensive left-sided radiographs of the extremities at yearly intervals. In this study, 262 subjects with 25,555 radiographs were screened for benign bone tumors at a median age of 8 years (range, 0 to 18 years). All potential tumors were reviewed by a multidisciplinary panel, which confirmed the radiographic diagnosis of each lesion, the age at which the lesion first appeared, and the age at which it had resolved. Prevalence rates were calculated using the number of distinct subjects available for each radiographic location and age.
Thirty-five tumors were identified in 33 subjects, including 19 nonossifying fibromas, 8 enostoses, 6 osteochondromas, and 2 enchondromas. The prevalence rate for all tumors combined increased with age and was 18.9% overall. The overall prevalence rates for specific tumor types were 7.5% for nonossifying fibromas, 5.2% for enostoses, 4.5% for osteochondromas, and 1.8% for enchondromas. Nonossifying fibromas demonstrated a bimodal distribution of prevalence, with a peak at 5 years (10.8%) and another after skeletal maturity (13.3%). The median age at the first appearance for all tumors combined was 9 years (range, 2 to 15 years), but varied by tumor type. Nonossifying fibromas often resolved (7 [37%] of 19), with further resolution possible beyond the last available radiograph. Enostoses, osteochondromas, and enchondromas persisted until the last available radiographs in all subjects.
The prevalence of benign childhood bone tumors of the extremities was 18.9% in a historical asymptomatic population. Longitudinal radiographs allowed observation of the timing of the first appearance and the potential for resolution for each tumor type. These findings provide unique evidence to answer many commonly encountered questions when counseling patients and their families on benign bone tumors.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
在儿童的影像学评估中，良性骨肿瘤是常见的偶发发现。为这些患者提供咨询需要保证，并提出了关于这些肿瘤随时间推移的自然病史的问题。本研究的目的是评估无症状人群中良性儿童骨肿瘤的患病率并观察其行为。
回顾性分析了一组历史上的、纵向的儿童健康影像学资料，其中包括每年对四肢进行全面的左侧射线照相检查。在这项研究中，对 262 名年龄中位数为 8 岁（0 至 18 岁）的受试者的 25555 张射线照片进行了良性骨肿瘤筛查。由一个多学科小组对所有疑似肿瘤进行了审查，该小组确认了每个病变的放射学诊断、首次出现病变的年龄以及病变消退的年龄。使用每个射线照相位置和年龄的不同个体数量计算患病率。
在 33 名受试者中发现了 35 个肿瘤，包括 19 个非骨化性纤维瘤、8 个内生骨瘤、6 个骨软骨瘤和 2 个软骨瘤。所有肿瘤的总患病率随年龄增长而增加，总体患病率为 18.9%。特定肿瘤类型的总体患病率分别为非骨化性纤维瘤 7.5%、内生骨瘤 5.2%、骨软骨瘤 4.5%和软骨瘤 1.8%。非骨化性纤维瘤的患病率呈双峰分布，5 岁时达到峰值（10.8%），骨骼成熟后再次升高（13.3%）。所有肿瘤联合的首次出现年龄中位数为 9 岁（范围为 2 至 15 岁），但因肿瘤类型而异。非骨化性纤维瘤常可消退（19 个中的 7 个[37%]），在最后一次可获得的射线照片之外仍可能进一步消退。内生骨瘤、骨软骨瘤和软骨瘤在所有受试者中均持续到最后一次可获得的射线照片。
在一项历史上无症状人群中，儿童四肢良性骨肿瘤的患病率为 18.9%。纵向射线照片可以观察到每种肿瘤类型的首次出现时间和潜在消退时间。这些发现为回答在为患者及其家属提供良性骨肿瘤咨询时经常遇到的许多问题提供了独特的证据。
预后 IV 级。请参阅作者指南，以获取完整的证据水平描述。
