2024年 · 第104卷第33期

A 21-year-old female went to the outpatient department of Zibo Hospital of Traditional Chinese Medicine for "left knee joint pain for 2 days". The patient reported that he had left knee joint pain without obvious trigger 2 days ago, but he was not treated and still moved normally. Prior health and no history of other diseases. Physical examination showed mild local tenderness of the left knee joint, acceptable flexion and extension of the left knee joint, normal muscle strength and muscle tone of the left lower limb, and normal skin sensation and blood supply at the extremity periphery. X-ray examination showed multiple spotty and short strip dense shadows of different sizes in the distal femur and proximal tibia of both knees, with clear boundaries, long axis parallel to the diaphysis, no joint invasion, and moderate joint space (Figures 1~3). Based on medical history, physical examination and imaging examination, the patient was diagnosed with osteoplastic disease. Spot of bone is a rare autosomal dominant genetic disorder believed to be caused by mutations in the LEMD3 gene and is a benign lesion with an incidence of one in fifty thousand, characterized by multiple osteosclerotic lesions. Most patients with osteoplastic disease are discovered by accident during imaging. The patient's treatment measures include advising the patient to pay attention to rest; Local hot compress treatment; Take aceclofenac tablets orally, 1 tablet twice daily. After 1 week, the pain symptoms of the patients were significantly reduced. After 1 month of follow-up, the patients' pain symptoms disappeared and did not relapse, and the patients were satisfied with the treatment results.

A 50-year-old female went to the General Hospital of the People's Liberation Army for "left hip pain with mobility restriction for 6 months". Six months ago, the patient developed left hip joint pain with limited movement without obvious trigger, which occurred during long walking and exertion, and relieved after rest. The above symptoms recurred, and oral diclofenac sodium and topical plaster showed no obvious effect. The patient's outpatient X-ray film showed bone hyperplasia at the outer upper margin of the left acetabulum, and the articular surface and articular space were normal. MRI of the left single hip showed bursal effusion around the left hip and edema around the round ligament (Figure 1, red arrow indicates the round ligament, green arrow indicates the cyst; Figure 2). Specialist examination: Tredelenburg sign (-), left inguinal midpoint tenderness (-), "4" word test (+), weakly positive femoral rolling test, modified hip Harris score (mHHS) 70, International Hip Outcome Tool score (iHOT-12) 56. After admission, arthroscopic left hip joint exploration and debridement showed intra-articular hyperplasia, synovial congestion and edema (Figure 3, arrow shows unruptured cyst under microscope; Figure 4); femoral head and acetabular cartilage were normal, labrum above acetabulum was torn, partially congested and edematous, and imprisoned in the joint space. A 1.5 cm ×1.0 cm cystic change appeared in the junction of the round ligament of the acetabular base, and brown cystic fluid flowed out when the cyst was punctured with a puncture needle. Circular ligament cyst resection, hip arthroplasty and labral suture were performed. There are pain receptors and mechanoreceptors in the round ligament, which are closely related to proprioception, pain perception, and overall stability of the joint. The pathological mechanism of round ligament cyst is still unknown, and it is considered that it is mostly caused by injury. The cyst wall should be cleanly removed during the operation to avoid recurrence of the cyst. This patient had repeated hip pain. MRI examination revealed bursal effusion around the left hip joint and edema around the round ligament. Combined with arthroscopy, it was diagnosed as cyst of the round ligament of the left hip joint.