- 期刊
職棒選手之有症狀的舟上骨意外發現：病例報告
Symptomatic Os Supranaviculare Incidentally Found in A Professional Baseball Player: A Case Report
摘要
背景：舟上骨（os supranaviculare）為一種罕見的骨骼解剖構造變異，盛行率約為1%，絕大多數的病人並無症狀，通常在腳踝受傷時或是舟上骨造成腳踝出現症狀，如活動時疼痛、腳踝腫脹等情況，接受檢查而意外發現，也時常被誤診為腳踝舟狀骨或距骨的壓力性骨折（stress fracture），需要仔細鑑別診斷，以免影響後續治療方向。病例報告：一名24歲男性運動員，為現役中華職業棒球大聯盟選手，主訴左腳踝背內側腫脹疼痛長達約六個月，不論於練習或比賽時，皆感到疼痛不適，曾經服用止痛藥物，也嘗試拉長休息時間等保守治療，但是成效不彰，而且症狀漸趨嚴重，左腳踝的活動角度也因為腳踝腫脹而受限，於是前來中山醫學大學附設醫院求診，在懷疑壓力性骨折情況下，安排一系列檢查，包括足部的X光檢查、腳踝超音波檢查以及核磁共振檢查，後來排除了運動員常見的壓力性骨折，並且意外發現左側舟上骨的存在，後續病人接受舟上骨移除手術（ostectomy），術後恢復良好並開始進行回到運動場前訓練。結論：舟上骨的發生率雖然不高，但臨床上若有懷疑時仍應特別留意，並仔細與腳踝舟狀骨或距骨的壓力性骨折做鑑別診斷，以利討論後續的治療方向，也能使病人有較好的預後。
並列摘要
Background: Os supranaviculare is a rare skeletal anatomical variation with a prevalence of approximately 1%. Most patients are asymptomatic. Typically, os supranaviculare is discovered incidentally after an ankle injury or when os supranaviculare causes symptoms such as pain during activities or swelling of the ankle,. Os supranaviculare is often misdiagnosed as a stress fracture of the navicular bone or talus. Careful differential diagnosis should be considered to avoid mistreatment. Case report: A 24-year-old male athlete, who is an active Chinese Major League Baseball player, complained of swelling and pain on the dorsomedial side of his left ankle for about six months. He felt persistent pain and discomfort during practices or in competitions. Previous attempts with conservative treatments such as prolonging rest periods or taking painkillers were unsatisfactory. His symptoms progressed, and his left ankle range became limited due to swelling of the ankle. Due to symptoms worsening, he came to Chung Shan Medical University Hospital for medical assistance. A series of examinations were arranged, including X-ray, ultrasound, and magnetic resonance imaging of the left foot due to suspicion of stress fracture. After the examinations, stress fracture, a common etiology of pain in athletes, was excluded, and left os supranaviculare was discovered incidentally. He returned to play training and recovered well after he received ostectomy of os supranaviculare. Conclusion: Although the incidence of os supranaviculare is not high, we should be vigilant at differentiating between os supranaviculare and stress fracture of the navicular bone or talus, since early diagnosis with proper treatment will allow for a better prognosis.