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

Image-guided percutaneous needle injection of methylprednisolone and injectable calcium sulfate for simple bone cysts

目的探讨在影像引导下经皮双针注射甲基泼尼松龙及注射型硫酸钙治疗单房性骨囊肿的方法与疗效。方法回顾性分析2006年10月至2010年8月治疗的单房性骨囊肿患者37例，男26例，女11例；年龄8-22岁，平均13．2岁。股骨近端病变5例，患者均有大腿近端酸痛、跛行等症状；肱骨近端病变32例，其中16例有上臂近端酸痛等症状，余16例无症状。术前均行X线、CT与MR检查。在“C”型臂X线机透视下将两枚穿刺针分别穿入囊腔内的近端与远端，欧乃派克造影确认两针相通，生理盐水反复冲洗后，注入甲基泼尼松龙120mg及可注射型硫酸钙，直至囊腔完全充填。根据改良Neer X线评级标准对骨囊肿愈合进行评估。结果术后住院1-3d，平均2．3d。术后每个月摄片复查，如连续2个月骨囊腔面积较前不再缩小则再次注射。37例患者中，6例注射2次，31例注射1次。注射后囊肿均愈合。改良Neer X线评级标准对骨囊肿愈合进行评估：术后3个月时随访37例，其中Ⅱ级6例，Ⅲ级8例，Ⅳ级23例；术后6个月时随访31例，其中Ⅱ级2例，Ⅲ级4例，Ⅳ级25例；术后24个月时随访26例，其中Ⅲ级3例，Ⅳ级23例；术后36个月时随访19例，均为Ⅳ级。结论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，具有创伤小、并发症少、术后恢复快等优点。

Objective To investigate the methods and therapeutic effects of image-guided percutaneous needle injection of methylprednisolone and injectable calcium sulfate for simple bone cysts. Methods Thirty-seven patients with simple bone cysts from October 2006 to August 2010 were analysed retrospectively in our hospital, including 26 males and 11 females with the average age of 13.2 years （range, 8-22 years）. Five cases of proximal remus lesions, with proximal thigh pain, limp and other symptoms. Thirty-two cases of proximal humeral lesions, 16 patients had proximal pain and other symptoms of upper arm, the other 16 cases were asymptomatic. Preoperative AP and lateral X-ray, CT and MRI were taken. Under the C-arm X-ray monitor, two needles were inserted into the proximal and distal of cysts respectively, Omnipaque contrast was injected to confirm the two needles is interlinked, then repeated rinsing with normal saline, then 120 mg methylprednisolone and injectable calcium sulfate were injected, till the cysts were full up. Patients after treatment were assessed according to modified Neer X-ray criteria. Results The average hospitalization was 2.3 days （range, 1-3 days）. X-ray was reviewed every month, additional injection was performed if bone cysts stopped decreasing for 2 consecutive months, injection 2 times in 6 cases, and 31 cases were injected only once. After 3 months follow-up 37 cases, according to modred Neer X-ray criteria, 6 cases regarded as gradeⅡ, 8 as grade Ⅲ, 23 as grade Ⅳ; after 6 months, 31 patients were followed up, including 2 cases as grade Ⅱ, 4 cases as grade Ⅲ, 25 as grade Ⅳ; after 24 months of follow-up 26 cases, 3 as grade Ⅲ, 23 as grade Ⅳ; after 36 months follow-up, 19 cases were all grade Ⅳ. Conclusion Imaging-guided percutaneous injection of methylprednisolone and injectable calcium sulfate for simple bone cysts has demonstrated, with less trauma, lower complications incidence and quicker recovery.