儿童髋臼周围病变的诊断与治疗

Diagnosis and Treatment of Periacetabular Lesion in Children

目的 探讨儿童髋臼周围病变的性质和预后。方法 从1997年7月至2000年6月对一组11例儿童髋臼周围病变,采取经皮穿刺活检,根据病理诊断结果,分别选择不同的处理方法。对髋臼顶壁塌陷者还进行了髋臼重建性手术。 结果 本组平均随访18个月.良性病变9例,其中单纯性骨囊肿4例、嗜酸性肉芽肿4例、亚急性骨髓炎1例;恶性病变2例(软骨肉瘤、尤文氏肉瘤各1例)。4例单纯性骨囊肿中,2例作刮除+植骨中1例复发,2例囊腔内注入甲基强的松龙而治愈;4例嗜酸性肉芽肿中2例自愈,2例因髋臼顶壁塌陷采取刮除和植骨重建髋臼手术,获得病变消失、恢复了髋臼的正常:形态;2例恶性肿瘤中1例放弃治疗,另1例软骨肉瘤第二次手术中发生意外而死亡。结论 儿童髋臼周围病变多为单纯性骨囊肿和嗜酸性肉芽肿,恶性肿瘤只占18.2％:囊腔内注入甲基强的松龙治疗单纯性骨囊肿是乎比刮除+植骨效果更好。

Objective To study the property and prognosis of periacetabular lesion in children. Method Eleven children with periacetabular lesion were diagnosed by percutaneous needle biopsy and treated with different approaches according the property of lesion from July 1997 to June 2000. Two collapsed acetabulum cases of complicated with eosinophilic granuloma were reconstructed with autogenous bone grafting. Result Nine of eleven children were followed up for average 18 months. Nine children were benign lesion; four of them were simple bone cyst and four of eosinophilic granuloma and one of subacute osteomyelitis. Two patients were diagnosed as malignant lesion. In the four cases of simple bone cyst, two were treated with curettage and autogenous bone grafting, and two were treated with injection of corticosteroids. There was only one recurrence, who is simple bone cyst. Of four cases with eosinophilic granuloma, two natural care without treatment, curettage, bone grafts and the acetabulum shapes reconstructed other two cases with collapsed acetabulum, their acetabulum were almost recovered to normal. Conclusion The periacetabular lesion in children were frequent benign lesion such as simple bone cyst and eosinophilic granuloma. The 18.2% of periacetabular lesion in this group was malignant lesions. Intralesional injection of corticosteroids for treatment of simple bone cysts had better efficacy.