儿童髂骨骨质破坏的诊断问题

Diagnostic issues of ilium bone destruction in children

目的探讨儿童髂骨骨质破坏的临床诊断及影像学表现特点。方法回顾性分析2007年7月至2015年4月经手术及组织病理证实的22例儿童髂骨骨质破坏临床资料，对其临床表现、影像学表现特点并结合病种分布情况进行分析。结果本组22例中以髋部疼痛为首发症状9例，下肢跛行5例，髋部疼痛伴低热4例，腰痛乏力2例，外伤后摄片无意中发现2例。所有病例影像学表现为髂骨不同形态的骨质破坏，发生在髂骨翼19例，髋臼3例。8例伴有大小不等的软组织肿块，2例见骨膜反应。病理诊断为神经母细胞瘤髂骨转移10例，骨嗜酸性肉芽肿5例，尤文氏肉瘤2例，骨髓炎2例，骨囊肿1例，骨纤维异样增殖症1例，非霍金氏淋巴瘤1例。结论儿童髂骨骨质破坏原因较多，以神经母细胞瘤髂骨转移和骨嗜酸性肉芽肿多见。临床表现以髋部疼痛和下肢跛行为首发症状居多。影像学表现具有一定的特点，骨质破坏多位于髂骨翼，呈溶骨性破坏为主，但特异性不高，确诊需病理检查。

ObjectiveTo explore the imaging features and differential diagnosis of ilium bone destruction in children.MethodsFrom July 2007 to April 2015, a total of 22 pathologically confirmed patients with ilium bone destruction were reviewed retrospectively. Age, gender, clinical features, anatomical sites, imaging characteristics and tumor types were analyzed.ResultsThere were 15 boys and 7 girls with an average treatment age of 6.2 years （11 months to 12 years）. Chief complaints included hip pain （n=9） and limping （n=5）. The involved side was left （n=6）, right （n=13） and bilateral （n=3）. There were metastasis of neuroblastoma （n=10）, eosinophilic granuloma of bone （n=5）, Ewing’s sarcoma （n=2）, osteomyelitis （n=2）, bone cyst （n=1）, fibrosacoma （n=1） and lymphoma （n=1）. The lesions were located at ala of ilium （n=19） or acetabulum （n=3）. Periosteal reaction （n=2） and soft tissue masses （n=8） were observed.ConclusionsGreat varieties of ilium bone destruction exist in children. Metastatic neuroblastoma and eosinophilic grunuloma are the most common tumors in childhood ilium. Childhood ilium with bone destruction have both some specific and non-specific imaging features. Other clinical findings and histopathology must be considered for making a definite diagnosis.