第180课 病例探析（028）—股骨纤维性骨皮质缺损

患者，男，13岁，右膝内侧疼痛并活动障碍1周，运动时疼痛加重，休息后减轻

右股骨远侧干骺端内后部见以不规则形骨质破坏区，长轴与骨干长轴一致，边缘清晰，有硬化缘。

CT扫描示右股骨远端干骺端内后部骨皮质及皮质下可见不规则形骨质破坏区，其内密度不均匀，可见多个骨性分隔影，似多囊状，边缘可见硬化缘。

        纤维性骨皮质缺损是一种非肿瘤性纤维性病变，系局部骨化障碍、纤维组织增生或骨膜下纤维组织侵入皮质所致，多数学者认为本病可能是儿童发育期的正常变异，大多数能自行消失。好发年龄为4-8岁，4岁以下少见，男性居多，好发部位为股骨远端和胫骨上端、下端内后侧骨皮质。典型X线表现为长骨干骺端内、后部，长轴与骨干长轴一致的椭圆形骨质缺损，有硬化缘，病灶大多距骺板在30mm以内，部分病灶内可见骨性分隔。CT表现为骨皮质有杯口或碟状缺损，深度可大于邻近骨皮质，以硬化线与骨髓腔分隔。

       Fibrous cortical bone defect is a kind of lesions, tumor fiber is local ossification, fibrous tissue hyperplasia or subperiosteal fibrous tissue caused by invasion of cortex, most scholars think that the disease might be growing normal variation, most will disappear on its own. Good hair age is 4-8 years old, 4 years old is rare, male majority, good hair place is the distal end of the femur and tibial upper end, inferior side of the posterior bone cortex. Typical X-ray show the inside and the back of the long bone epiphysis end, long axis is consistent with the long axis of the backbone of the oval bone defect, hardened, most lesions from epiphyseal plate within the 30 mm, part of the bony space can be seen in the lesion. CT showed that the bony cortex had a cup or plate defect, which was greater than the adjacent bone cortex, which was separated from the bone marrow cavity by hardening line.

        本例应与儿童干骺端结核、骨样骨瘤鉴别。儿童干骺端结核 常发生于干骺端松质骨内，可跨越骺板，病灶内可有沙砾状钙质样高密度死骨，密度不均，病灶周围常伴有骨髓水肿、软组织肿胀，临床表现有结核中毒症状。骨样骨瘤的病灶周围局部疼痛、压痛明显，常伴有夜间痛，瘤巢内常见不均匀钙质样高密度影，周围骨质广泛增厚。

        This case should be identified with the epiphyseal terminal tuberculosis and osteoid osteoma of children. Children tuberculosis often occurs in dry stem epiphyseal end in cancellous bone epiphysis end, crossing the epiphyseal plate, lesions can be kind of gravel calcium in high density dead bone, uneven density, around the lesions often accompanied by bone marrow edema, soft tissue swelling, clinical manifestations have tuberculosis poisoning symptoms. The lesion of osteoid osteoma is obvious with local pain and tenderness. It is often accompanied by night pain.