一例由巨大继发性滑膜骨软骨瘤病引起的盂肱关节撞击症病例

IF 0.6 Q4 SURGERY

International Journal of Surgery Case Reports Pub Date : 2024-10-26 DOI:10.1016/j.ijscr.2024.110527

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引用次数: 0

摘要

导言和重要性肩关节滑膜骨软骨瘤病主要是原发性的，以多发性骨软骨碎片为特征，继发性滑膜骨软骨瘤病的报道很少见。病例介绍患者是一名 48 岁的男性，因右肩疼痛持续数月而到我院就诊。虽然活动范围没有明显受限，但在水平内收和外旋时出现疼痛。X光片和CT扫描显示盂肱关节内有一个骨软骨松动体，盂腔前缘有一个骨质增生。盂肱关节内的利多卡因试验呈阳性，表明松动体造成了撞击，因此需要进行手术切除。在关节镜下，松动体从盂肱关节前侧被抓取并移除。骨软骨碎片长约15毫米，包括软组织在内的总长度约为40毫米。病理结果显示滑膜细胞分层排列，与继发性滑膜骨软骨瘤病一致。术后，肩部疼痛迅速改善，术后 6 个月随访结束。临床讨论在该病例中，关节镜检查发现盂唇上有希尔-萨克斯样病变和唇缺损，提示曾有外伤。然而，并未观察到与松动体大小相匹配的骨缺损。在继发性滑膜骨软骨瘤病中，小的骨软骨碎片可以在滑膜的滋养下生长，这表明本病例中的松动体可能同样是在创伤后增大的。结论通过关节镜切除松动体，巨大的继发性滑膜骨软骨瘤病引起的肩部疼痛得到了改善。

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A case of glenohumeral joint impingement caused by a giant secondary synovial osteochondromatosis

Introduction and importance

Synovial osteochondromatosis of the shoulder joint is predominantly primary, characterized by multiple osteochondral fragments, with reports of secondary synovial osteochondromatosis being rare.

Case presentation

The patient, a 48-year-old male, presented to our hospital with right shoulder pain persisting for several months. While there was no significant restriction in the range of motion, pain was noted during horizontal adduction and external rotation in the dependent position. Radiographs and CT scans revealed an osteochondral loose body in the glenohumeral joint and an osteophyte on the anterior margin of the glenoid cavity. A lidocaine test in the glenohumeral joint was positive, suggesting impingement by the loose body, leading to its surgical removal. Arthroscopically, the loose body was grasped and removed from the anterior aspect of the glenohumeral joint. The osteochondral fragment measured approximately 15 mm, with the total length including soft tissue being about 40 mm. Pathological findings indicated a layered arrangement of synovial cells, consistent with secondary synovial osteochondromatosis. Postoperatively, the shoulder pain improved rapidly, and follow-up was concluded six months after surgery.

Clinical discussion

In this case, arthroscopy revealed a Hill-Sachs-like lesion and labral deficiency on the glenoid, suggesting past trauma. However, no bone defect matching the size of the loose body was observed. In secondary synovial osteochondromatosis, small osteochondral fragments can grow with nourishment from the synovium, suggesting the loose body in this case might have similarly enlarged post-trauma.