儿童四肢动脉瘤样骨囊肿的临床特点和术后复发因素分析  

Characteristics and postoperative recurrence factors of aneurysmal bone cyst in children′s limbs

作　　者：胡奇哲 李贤枫 张天久 杨小红 徐艳朋 吕欣 Hu Qizhe;Li Xianfeng;Zhang Tianjiu;Yang Xiaohong;Xu Yanpeng;Lyu Xin(Department of Pediatric Orthopedic Surgery,Affiliated Hospital of Zunyi Medical University,Zunyi 563000,China)

机构地区：[1]遵义医科大学附属医院小儿骨科,遵义563000

出　　处：《中华实用儿科临床杂志》2022年第13期1006-1010,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：遵义医学院2017年度学术新苗培养及创新探索课题-黔科合平台人才((2017)5733-031)。

摘　　要：目的分析儿童动脉瘤样骨囊肿(ABC)的临床特点和术后复发相关因素,提高儿童ABC的临床诊治水平。方法回顾性分析遵义医科大学附属医院2010年1月至2018年12月收治经术后病理诊断为ABC患儿的临床资料,对其临床特点,包括年龄、性别、病变部位、主要临床表现(疼痛、肿胀、局部压痛、关节功能障碍、病理性骨折)进行分析总结;术前采用影像学Enneking分期、估算囊肿体积、测量囊肿至骺板的距离,采用病灶刮除、局部烧灼和植骨术治疗,病理性骨折术中辅助内固定,术后采用Neer影像学分级进行结果判定,其中Ⅰ级和Ⅱ级为术后复发,对可能的复发因素采用Fisher′s精确检验法进行统计学分析。结果共纳入符合标准的病例29例,其中男19例,女10例;年龄3.6~14.0岁,平均9.2岁;≤10岁组12例,>10岁组17例;股骨近端9例(31.0%),肱骨近端5例(17.2%),腓骨近端4例(13.8%),其余11例(37.9%)发生在中远端;26例(89.7%)有局部压痛表现,25例(86.2%)表现有不同程度的疼痛,18例(62.1%)有局部肿胀,15例(51.7%)有关节功能障碍,12例(41.4%)合并病理性骨折。根据Enneking分期:静止期18例(62.1%),活跃期7例(24.1%),侵袭期4例(13.8%);估算囊肿体积为3.3~172.0 cm^(3),中位数体积约为50.8 cm^(3);囊肿至骺板距离为0~85.0 mm,中位数距离为20.8 mm。所有患儿术后随访2.2~10.1年,平均3.8年。根据Neer分级标准判定,Ⅰ级和Ⅱ级共6例(20.7%),复发时间为术后2.5~20.3个月,平均12.5个月。囊肿体积>50.8 cm3组术后复发率(42.9%,6/14例)较高(P<0.05),活跃期和侵袭期术后复发率(45.5%,5/11例)较高(P<0.05),不同性别、年龄、囊肿至骺板距离、病理性骨折之间ABC术后复发率比较差异无统计学意义。结论儿童ABC易发生于四肢长骨近侧干骺端,主要以疼痛、肿胀、局部压痛、关节功能障碍为主要表现,易合并病理性骨折。ABC囊肿体积较大、病变处于活跃期和侵袭期,术后复发Objective To analyze the characteristics of aneurysmal bone cysts(ABC)and related factors of postoperative recurrence,so as to improve the clinical diagnosis and treatment level of ABC in children.Methods The clinical data of children pathologically diagnosed as ABC after surgery in the Affiliated Hospital of Zunyi Medical University from January 2010 to December 2018 were retrospectively analyzed.Clinical characteristics of the patients,including age,gender,lesion sites,and main clinical manifestations(pain,swelling,local tenderness,joint dysfunction and pathological fracture)were analyzed and summarized.Before operation,imaging Enneking staging was carried out,cyst volume was estimated,and the distance from cysts to the epiphyseal plate was measured.During surgery,patients received lesion curettage,local cautery and bone grafting,and the pathological fractures were treated with auxiliary internal fixation.Results were determined by Neer imaging grading after surgery,and gradesⅠandⅡwere postoperative recurrence.Possible recurrence factors were analyzed statistically by Fisher′s exact test.Results A total of 29 cases meeting the criteria were included,including 19 males and 10 females.The age ranged from 3.6 to 14.0 years old,averaging 9.2 years old;12 patients were smaller than 10 years old and 17 patients were older than 10 years old.The cysts of 9 cases were located in proximal femur(31.0%),5 cases in proximal humerus(17.2%),and 4 cases in proximal fibula(13.8%);The other 11 cases(37.9%)occurred in the middle and distal end;26 cases(89.7%)had local tenderness,25 cases(86.2%)showed varying degrees of pain,18 cases(62.1%)presented local swelling,15 cases(51.7%)were accompanied by joint dysfunction,and 12 cases(41.4%)were combined with pathological fractures.According to Enneking staging results,18 cases(62.1%)were at rest stage,7 cases(24.1%)at active stage,and 4 cases(13.8%)at invasive stage.Cyst volume was estimated to be 3.3-172.0 cm^(3),with a median of about 50.8 cm^(3).The distance from cysts to the

关 键 词：儿童 动脉瘤样骨囊肿 临床特点 复发 

分 类 号：R726.8[医药卫生—儿科]