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1、·1014·ChineseJReparativeandReconstructiveSurgery,2006,Vol20(10)成骨肉瘤早期临床表现特点吴苏稼施鑫赵建宁王与荣张俊周利武陈跃先周光新【摘要】目的试图找出成骨肉瘤早期临床表现的特点和规律,为其早期诊断提供帮助。方法1984年4月～2002年10月,收治成骨肉瘤92例,对其中71例记录及检查齐全的患者首次就诊时的临床表现、诊断和确诊拖延的时间等进行调查和记录。男42例,女29例。年龄6～66岁,平均17.4岁。病程1～28周,所有患者均经病理诊断证实为四肢的成骨肉瘤,其中
2、股骨下段38例,胫骨上段22例,股骨上段3例,腓骨上段3例,肱骨上段2例,胫骨下段2例,桡骨远端1例。结果71例患者中,有70例患者首次就诊为局部疼痛和ö或包块。37例有昼夜无明显区别的持续性疼痛,23例为间隙性痛,11例为夜间痛。42例最初疼痛的出现与外伤有关,其中3例发生病理性骨折。首诊有局部包块者,医生拖延诊断时间1～14周,平均4周;未发现局部包块者,医生拖延诊断时间为3～30周,平均14周。首诊X线片检查者,医生拖延诊断时间1～20周,平均8周;未行X线片检查者,医生拖延诊断时间为4～30周,平均16周。结论间隙性和持
3、续性疼痛及局部包块是成骨肉瘤患者早期最具特征性的表现,外伤往往是发现早期成骨肉瘤症状的一个因素。对关节周围出现疼痛且反复发作的青少年患者应给予细致的临床检查和观察。【关键词】成骨肉瘤早期诊断临床特点中图分类号:R738.1R730.4文献标识码:AEARLYCLINICALMANIFESTATIONSOFOSTEOGENICSARCOMAöWUSujia,SHIXin,ZHAOJianning,etal.DepartmentofOrthopedics,NanjingGeneralHospitalofPeople'sLiberat
4、ionArmy,NanjingJiangsu,210002,P.R.ChinaCorrespondingauthor:WUSujia,E2mail:wusujia@yahoo.com.cn【Abstract】ObjectiveToinvestigateearlyclinicalmanifestationsofosteogenicsarcomatohelpestablishmentofanearlydiagnosisofthedisease.MethodsAtotalof92patientswithosteogenicsarcom
5、aintheextremitieswereadmittedtoourhospitalfromApril1984toOctober2002.Ofthe92patients,71(42malesand29females;averagedage17.4years,range6266years;illnesscourse1228weeks)hadacompleterecordoftheirmedicalhistoryandexamination.Fromtheirfirstmedicalvisits,weobtainedtheircli
6、nicalsymptoms,physicalsings,diagnoses,anddurationofthedelayeddiagnoses.Thepatientswerepathologicallyconfirmedashavingosteogenicsarcomaintheextremities,withthelesionslocatedinthedistalfemurin38patients,proximaltibiain22,proximalfemurin3,proximalfibulain3,proximalhumer
7、usin2,distaltibiain2,anddistalradiusin1.ResultsOfthe71patients,70hadalocalpainandöorapalpablemass,37hadapersistentpainwithnodifferencebetweendayandnight,23hadanintermittentpain,and11hadanocturnalpain.Ofthe71patients,42hadaninitialpainrelatedtotrauma,and3ofthe42patien
8、tshadapathologicfracture.Thepatientswiththelocalmasshadadelayeddiagnosisofosteogenicsarcomawithadelayeddurationof1214weeks,averaged
