摘要
目的探讨儿童四肢原发性动脉瘤样骨囊肿（aneurysmal bonecysts，ABC）不同治疗方法的疗效，研究弹性髓内钉的应用于原发性动脉瘤样骨囊肿的效果。方法回顾性分析2012年1月至2016年6月我院收治21例的四肢原发性动脉瘤样骨囊肿患儿资料，其中男18例，女3例，年龄1～14岁，中位年龄5岁。21例病变主要位于股骨、胫骨、腓骨及肱骨。根据治疗方案不同将患儿分为两组：病灶刮除植骨＋电刀磨钻＋弹性髓内钉内固定术组（内固定组）以及病灶刮除植骨＋电刀磨钻术组（无内固定组）。根据Neer分级及骨骼肌肉肿瘤学会（musculoskeletal tumor society，MSTS）功能评价，统计两组患儿的预后结果。结果21例患儿均随访2年以上，随访时间为24～48个月，平均随访时间为（32．29～8．22）个月。5例复发，复发时间平均为术后（10±2．66）个月。21例中内固定组16例，无内固定组5例。内固定组Neer分级预后评价：Ⅰ级3例，Ⅲ级1例，Ⅳ级12例；无内固定组为：Ⅰ级1例，Ⅱ级1例，Ⅲ级2例，Ⅳ级1例。内固定组ABC复发率18．8％，明显低于无内固定组的40％，但差异无统计学意义（χ2=0．880，P=0．338）。内固定组术后MSTS功能评分为（28．88±2．22）分，明显较无内固定组的（20．80±10．38）分高，差异有统计学差异（t=3．058，P=0．006）。即便复发的内固定组患儿同样能进行活动而未出现病理性骨折，术后生活质量可大大提高。结论刮骨植骨＋电刀磨钻＋髓内钉内固定术能明显降低四肢原发性动脉瘤样骨囊肿复发率，同时该组复发病例MSTS功能评价均达到满意程度，复发可能与患儿年龄及病灶与骺板距离相关，合理的治疗方案选择有助于控制复发率并提高患儿术后的生活质量。
Objective To compare the treatment effect and study the efficacy of the elastic intramedullary nails for the treatment of primary aneurysmal bone cysts in limbs. Methods Twenty one children with primary aneurysmal bone cystsadmit- ted to and treated in Shanghai Children＇s Hospital from 2012 January to 2016 June were studied retrospectively. There were 18 males and 3 females, with overall age of 1-14 years old and median age of 5 years old. The lesions were mainly located in the fe- mur, tibia, fibula and humerus. They were divided into 2 groups according to the treatment plan. The patients of the experiment- group received curettage and bone grafts with high-speed burring and elastic intramedullary nail. The patients of the control group received curettage and bone grafts with high-speed burring. According to the imaging results （Neer grading） and MSTS functional evaluation, the curative effect of the children of the 2 groups were analyzed statistically. Results The cure children were followed up for more than 2 yearswith follow-up time range of 24-48 months （mean value of 32.29±8.22 months）. Five patients had a recur- rence, with mean postoperative recurrence time of 10±2.66 months. A total of 5 patients of the control group perceived curettage and bone grafts with high-speed burring and a total of 16 patients of the experimentgroup received curettage and bone grafts with high-speed burring andelastic intramedullary nail. According to the imaging results （Neer grading） and MSTS function evaluation, Neer grading was 3 cases for grade Ⅰ, 0 case for grade Ⅱ, 1 case for grade Ⅲ and 12 cases for grade IV in the experiment groups. That was 1 case for grade Ⅰ, 1 case for grade Ⅱ, 2 cases for grade Ⅲ and 1 case for grade IV in the control group. The ABC recur- rence rate of experimental group （18.8%） was lower than matched group （40%）, while there was no significant difference. We found that MSTS functional scores of experimental group was significantly higher than the matched group �
作者
王一臣
焦勤
赵利华
贾幸
董良超
沈阳
王隼
WangYichen;Jiao Qin;Zhao Lihua;Jia Xing;Dong Liangchao;Shen Yang;Wang Sun(Department of Orthopaedics,Shanghai Children＇s Hospital,Shanghai Jiaotong University,Shanghai 200040,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2018年第18期1108-1115,共8页
Chinese Journal of Orthopaedics
基金
国家自然科学基金青年项目（81401763）
关键词
骨囊肿
动脉瘤样
内固定器
治疗结果
生活质量
Bone cysts
aneurysmal
Internal fixators
Treatment outcome
Quality of life
