自体骨髓注射治疗单纯性骨囊肿的影像学变化与临床意义

A radiologic follow-up of autolognous bone marrow injection of simple bone cysts

目的观测自体骨髓注射治疗单纯性骨囊肿的影像学改变,分析其临床意义。方法自体骨髓注射治疗单纯性骨囊肿患儿27例,获随访25例,随访平均3．3年。以CR摄影判定影像学上的疗效;观测术后不同时期X线骨囊肿面积、皮质厚度的变化情况;分术前合并病理骨折组及无病理骨折组,测算术前囊肿纵径／最小皮质厚度,行组间比较。通过三维CT结合X线观察骨囊肿的基本愈合形式。结果1次注射后愈合10例,缺损愈合5例,持续存在7例(含2例无反应),复发3例。除外无反应者,术后3个月病灶内均有不同程度的密度增高;X线骨囊肿面积基本稳定,主要发生在术后6-9个月(21／23);X线骨囊肿皮质厚度基本稳定,主要发生在术后9个月-1年(19／23)。除外下肢持重管状骨病变,术前合并病理骨折组及无病理骨折组囊肿纵径与最小皮质厚度比值差异显著。结论自体骨髓注射治疗单纯性骨囊肿术后随访至少1年;该法通过骨皮质增厚,囊腔内骨嵴及骨小梁向心性增生,分割包绕填塞囊腔而逐步愈合。

Objective To review our result of autologous bone marrow injection of simple bone cyst by serial computer X-ray radiographs and CT scans. Methods Twenty-seven consecutive patients with simple bone cysts were treated by aspiration and injection of autologous bone marrow. They were followed up for an average of 3. 3 years （1.5-5.5years）, with 2 cases lost in the follow-up. Changes of serial computer radiographs and CT scans were studied and measured digitally. Results After one injection, 10 cysts （40%） were completely healed, 5 cysts （20%） healed with defect, three cysts （12%） recurred , and 7 cysts （28%） were persistent including 2 （8%） cases with no response. Thirteen patients （52%） needed repeated injections. Except for the cases with no response, the other cysts had radiological changes within 3 months. The bone cyst areas and the cortical thickness changed very little during the period 6 to 12 months after the injection. Except for Femeral and tibial cysts, there was significant change in the ratio （cystic length/minimal cortical width） in groups with and without preoperative pathologic fractures. Conclusions In treating simple bone cyst, autologous bone marrow injection should be followed-up for at least one year. The cysts heal by formation of trabecular septae and cortex thickening.