自体骨髓血注射结合弹性髓内针治疗儿童长骨骨囊肿
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摘要
目的:观察自体骨髓血注射结合弹性髓内针植入方法治疗儿童长骨骨囊肿的临床疗效。方法:自2010年1月至2015年12月采用自体骨髓血注射结合弹性髓内针植入的方法治疗儿童长骨骨囊肿29例,男22例,女7例;年龄2～12岁,平均7.7岁;病程12～84个月。其中肱骨近端17例,股骨近端9例,股骨远端2例,尺骨近端1例。全部骨囊肿患儿行术前X线片检查,必要时加做CT或MRI检查,明确诊断后,治疗方法采用骨髓血注射结合弹性髓内针支撑引流,术后行多次X线检查随访,采用Capanna骨囊肿治疗评价标准进行疗效评价。结果:29例患儿中27例获得随访,随访时间12～60个月,平均31.8个月。按照Capanna骨囊肿评价标准,其中26例治愈,1例部分愈合残留部分病灶。结论:采用自体骨髓血注射结合弹性髓内针治疗单纯性儿童长骨骨囊肿具有疗效确定、高治愈率、并发症少、治疗过程客观可控的特点。
Objective : To observe the clinical effect of autologous bone marrow blood injection combined with elastic intramedullary needle implantation in the treatment of long bone cyst in children. Methods:From January 2010 to December2015,29 children with long bone cyst were treated with autologous bone marrow blood injection combined with elastic intramedullary nail implantation, including 22 males and 7 females,aged 2 to 12 years old with an average age of 7.7 years old,and the course of disease was 12 to 84 months. Among them, 17 cases were proximal humerus,9 cases were proximal femur,2 cases were distal femur and 1 case was proximal ulna. All children with bone cyst underwent preoperative X-ray examination and CT or MRI examination if necessary. After definite diagnosis,bone marrow blood injection combined with elastic intramedullary needle support and drainage were used as treatment methods. After operation, multiple X-ray examination and follow-up were carried out. The curative effect was evaluated with Capanna bone cyst treatment evaluation criteria. Results :Twenty-seven of 29 children were followed up for 12 to 60 months with an average of 31.8 months. According to the evaluation criteria of Capanna bone cyst,26 cases were cured and 1 case was partially healed with residual lesions. Conclusion: Autologous bone marrow blood injection combined with elastic intramedullary needle has the characteristics of definite curative effect,high cure rate, fewer complications and objectively controllable treatment process for simple long bone cyst in children.
Objective : To observe the clinical effect of autologous bone marrow blood injection combined with elastic intramedullary needle implantation in the treatment of long bone cyst in children. Methods:From January 2010 to December2015,29 children with long bone cyst were treated with autologous bone marrow blood injection combined with elastic intramedullary nail implantation, including 22 males and 7 females,aged 2 to 12 years old with an average age of 7.7 years old,and the course of disease was 12 to 84 months. Among them, 17 cases were proximal humerus,9 cases were proximal femur,2 cases were distal femur and 1 case was proximal ulna. All children with bone cyst underwent preoperative X-ray examination and CT or MRI examination if necessary. After definite diagnosis,bone marrow blood injection combined with elastic intramedullary needle support and drainage were used as treatment methods. After operation, multiple X-ray examination and follow-up were carried out. The curative effect was evaluated with Capanna bone cyst treatment evaluation criteria. Results :Twenty-seven of 29 children were followed up for 12 to 60 months with an average of 31.8 months. According to the evaluation criteria of Capanna bone cyst,26 cases were cured and 1 case was partially healed with residual lesions. Conclusion: Autologous bone marrow blood injection combined with elastic intramedullary needle has the characteristics of definite curative effect,high cure rate, fewer complications and objectively controllable treatment process for simple long bone cyst in children.
引文
[1]史立伟,张立军,赵群,等.弹性髓内针支撑并引流治疗肱骨骨囊肿的疗效评价[J].中国骨与关节杂志,2015,4(10):748-752.SHI LW,ZHANG LJ,ZHAO Q,et al.Evaluation of elastic intramedullary pin support and drainage for treatment of humeral bone cyst[J].Zhongguo Gu Yu Guan Jie Za Zhi,2015,4(10):748-752.
[2]Capanna R,Dal Monte A,Gitelis S,et al.The natural history of unicameral bone cyst after steroid injection[J].Clin Orthop Relat Res,1982,(166):204-211.
[3]Roposch A,Saraph V,Linhart WE.Flexible intramedullary nailing for the treatment of unicameral bone cysts in long bones[J].J Bone Joint Surg Am,2000,82(10):1447-1453.
[4]种涛,胡永成,万宁军,等.影像引导下经皮穿刺注射甲基泼尼松龙及注射型硫酸钙治疗单房性骨囊肿[J].中华骨科杂志,2011,31(6):582-586.CHONG T,HU YC,WAN NJ,et al.Percutaneous injection of methylprednisolone and injectable calcium sulfate for single chamber bone cyst under image guidance[J].Zhonghua Gu Ke Za Zhi,2011,31(6):582-586.Chinese.
[5]蒋晖,徐礼森,王光斌,等.类固醇注射治疗单纯性骨囊肿[J].中国骨伤,2005,18(6):364-365.JIANG H,XU LS,WANG GB,et al.Treatment of simple bony cyst with injection of corticosteroid[J].Zhongguo Gu Shang/China J Orthop Trauma,2005,18(6):364-365.Chinese.
[6]孟叶新,蒋唯强,陈文福.异体骨移植结合中药治疗儿童孤立性骨囊肿[J].中国骨伤,2002,15(2):108-109.MENG YX,JIANG WQ,CHEN WF.Treatment of solitary bone cyst with heterogenous bone transplantation combined with Chinese herb medicine[J].Zhongguo Gu Shang/China J Orthop Trauma,2002,15(2):108-109.Chinese.
[7]唐浩琛,王正红,向明.同种异体骨移植治疗儿童骨囊肿[J].中国骨伤,2008,21(12):928-929.TANG HC,WANG ZH,XIANG M.Allogeneic bone graft for the treatment of children's bone cyst[J].Zhongguo Gu Shang/China JOrthop Trauma,2008,21(12):928-929.Chinese.
[8]明小平,王小林,邵景范,等.应用弹性髓内钉治疗儿童长骨瘤样病变并病理性骨折[J].骨科,2016,7(3):176-180.MING XP,WANG XL,SHAO JF,et al.Application of elastic intramedullary nail in the treatment of long bone tumor and pathological fracture in children[J].Gu Ke,2016,7(3):176-180.Chinese.
[9]De Sanctis N,Andreacchio A.Elastic stable intramedullary nailing is the best treatment of unicameral bone cysts of the long bones in children Prospective long term follow up study[J].J Pediatr Orthop,2006,26(4):520-525.
[10]Knott P,Schmittenbecher PP,Dietz HG.Elastic stable intramedullary nailing for the treatment of complicated juvenile bone cysts of the humerus[J].Eur J Pediatr Surg,2003,13(1):44-49.
[11]雍明,楼跃.弹性髓内针留置引流治疗儿童单纯性骨囊肿的疗效分析[J].中国矫形外科杂志,2016,24(21):2007-2009.YONG M,LOU Y.Effect of elastic intramedullary pin drainage on simple bone cyst in children[J].Zhongguo Jiao Xing Wai Ke Za Zhi,2016,24(21):2007-2009.
[12]Neer CS 2nd,Francis KC,Marcove RC,et al.Treatment of unicameral bone cyst.A follow up study of one hundred seventy five cases[J].J Bone Joint Surg Am,1966,48(4):731-745.
[13]Cha SM,Shin HD,Kim KC,et al.Flexible intramedullary nailing in simple bone cysts of the proximal humerus:prospective study for high risk cases of pathologic fracture[J].J Pediatr Orthop B,2013,22(5):475-480.
[2]Capanna R,Dal Monte A,Gitelis S,et al.The natural history of unicameral bone cyst after steroid injection[J].Clin Orthop Relat Res,1982,(166):204-211.
[3]Roposch A,Saraph V,Linhart WE.Flexible intramedullary nailing for the treatment of unicameral bone cysts in long bones[J].J Bone Joint Surg Am,2000,82(10):1447-1453.
[4]种涛,胡永成,万宁军,等.影像引导下经皮穿刺注射甲基泼尼松龙及注射型硫酸钙治疗单房性骨囊肿[J].中华骨科杂志,2011,31(6):582-586.CHONG T,HU YC,WAN NJ,et al.Percutaneous injection of methylprednisolone and injectable calcium sulfate for single chamber bone cyst under image guidance[J].Zhonghua Gu Ke Za Zhi,2011,31(6):582-586.Chinese.
[5]蒋晖,徐礼森,王光斌,等.类固醇注射治疗单纯性骨囊肿[J].中国骨伤,2005,18(6):364-365.JIANG H,XU LS,WANG GB,et al.Treatment of simple bony cyst with injection of corticosteroid[J].Zhongguo Gu Shang/China J Orthop Trauma,2005,18(6):364-365.Chinese.
[6]孟叶新,蒋唯强,陈文福.异体骨移植结合中药治疗儿童孤立性骨囊肿[J].中国骨伤,2002,15(2):108-109.MENG YX,JIANG WQ,CHEN WF.Treatment of solitary bone cyst with heterogenous bone transplantation combined with Chinese herb medicine[J].Zhongguo Gu Shang/China J Orthop Trauma,2002,15(2):108-109.Chinese.
[7]唐浩琛,王正红,向明.同种异体骨移植治疗儿童骨囊肿[J].中国骨伤,2008,21(12):928-929.TANG HC,WANG ZH,XIANG M.Allogeneic bone graft for the treatment of children's bone cyst[J].Zhongguo Gu Shang/China JOrthop Trauma,2008,21(12):928-929.Chinese.
[8]明小平,王小林,邵景范,等.应用弹性髓内钉治疗儿童长骨瘤样病变并病理性骨折[J].骨科,2016,7(3):176-180.MING XP,WANG XL,SHAO JF,et al.Application of elastic intramedullary nail in the treatment of long bone tumor and pathological fracture in children[J].Gu Ke,2016,7(3):176-180.Chinese.
[9]De Sanctis N,Andreacchio A.Elastic stable intramedullary nailing is the best treatment of unicameral bone cysts of the long bones in children Prospective long term follow up study[J].J Pediatr Orthop,2006,26(4):520-525.
[10]Knott P,Schmittenbecher PP,Dietz HG.Elastic stable intramedullary nailing for the treatment of complicated juvenile bone cysts of the humerus[J].Eur J Pediatr Surg,2003,13(1):44-49.
[11]雍明,楼跃.弹性髓内针留置引流治疗儿童单纯性骨囊肿的疗效分析[J].中国矫形外科杂志,2016,24(21):2007-2009.YONG M,LOU Y.Effect of elastic intramedullary pin drainage on simple bone cyst in children[J].Zhongguo Jiao Xing Wai Ke Za Zhi,2016,24(21):2007-2009.
[12]Neer CS 2nd,Francis KC,Marcove RC,et al.Treatment of unicameral bone cyst.A follow up study of one hundred seventy five cases[J].J Bone Joint Surg Am,1966,48(4):731-745.
[13]Cha SM,Shin HD,Kim KC,et al.Flexible intramedullary nailing in simple bone cysts of the proximal humerus:prospective study for high risk cases of pathologic fracture[J].J Pediatr Orthop B,2013,22(5):475-480.