骨水泥在儿童特殊骨病变中的临床应用  

The clinical application of bone cement for special bone diseases in children

作　　者：夏天[1] 宁波[1] 宋君[1] 裴新红[1] 王达辉[1] 马瑞雪[1] 

机构地区：[1]复旦大学附属儿科医院骨科,上海201102

出　　处：《中国骨与关节杂志》2017年第6期455-461,共7页Chinese Journal of Bone and Joint

摘　　要：目的观察骨水泥填充治疗难以应用植骨的小儿骨病变的疗效及分析。方法 2012年5月至2016年5月期间我院收治进行骨水泥填充治疗骨病变10例(11处)。其中男8例,女2例,年龄2~15岁,平均8.2岁;感染性病变7例(骨结核4例、非特异型感染3例)、肿瘤及肿瘤样病变3例(软骨母细胞瘤2例、骨纤维结构不良1例);股骨5例、胫骨3例、尺骨1例、髂骨1例、髋臼1例。手术中先对病灶取活检,冰冻病理提示病变为感染或无法植骨的肿瘤后,对病灶彻底清创,以骨水泥填充骨缺损区,1例同时使用外固定架和髓内钉固定。术后石膏固定6~12周,目前术后骨水泥尚未取出。结果随访时间6~36个月,平均22.4个月。随访患儿中,感染或肿瘤性病变均无复发,无疼痛,无病理性骨折发生。累及下肢骨患儿,均恢复完全负重。受累关节活动度得到改善。1例慢性骨髓炎患儿因病灶完全破坏胫骨远端骨骺,术后1年出现胫骨短缩、踝内翻,余患儿受累骨力线良好。结论骨水泥对小儿骨感染病变和无法植骨的肿瘤性病变进行填充治疗的疗效显著,可有效地缓解患者的临床症状,降低其病情的复发率。该方法为难治性儿童骨病变提供了一种良好的治疗选择。Objective To explore the therapeutic effects of bone cement filling for bone diseases in children when bone graft is infeasible. Methods Between May 2012 and May 2016, 10 children （ 11 sites ） with bone diseases underwent bone cement filling. There were 8 males and 2 females, whose mean age was 8.2 years （ range： 2 - 15 years ） at the time of operation. There were 7 cases of infections, including 4 cases of bone tuberculoses and 3 cases of nonspecific infections, and 3 cases of tumors and tumor-like lesions, including 2 cases of chondroblastoma and 1 case of osteofibrous dysplasia. The sites were located in the femur （ n = 5 ）, tibia （ n = 3 ）, ulna （ n = 1 ）, ilium （ n = 1 ） and acetabulum （ n = 1 ）. During the operation, frozen surgical pathologic specimens were taken. If infection or benign aggressive bone tumor was confirmed after frozen-section diagnosis, the patient would be treated by curettage and bone cement filling. Besides that, the external fixator and intramedullary nail were used for 1 case. The involved limbs were fixed in the cast for 6 to 12 weeks. Bone cement hadn＇t been removed until now. Results The mean follow- up time was 22.4 months （ range： 6 - 36 months ）. There was no recurrence or pathological fracture. The patients no longer suffered from pain, and the range of motion of the joint was improved. All the patients whose lower limb bone got involved could walk. Leg length discrepancy and ankle varus were noted in 1 patient with chronic osteomyelitis at 1 year after operation because the epiphyseal plate of the distal tibia was destroyed. Bone line was fine in all the other children. Conclusions Bone cement filling is an effective method to treat infections and tumor-like lesions that cannot be treated by bone graft in children, which can relieve patients＇ clinical symptoms and reduce the recurrence rate. This is a good treatment option for intractable bone diseases in children.

关 键 词：骨水泥成形术 骨肿瘤 儿童 骨感染 

分 类 号：R726.8[医药卫生—儿科]