儿童长骨非骨化性纤维瘤的诊疗与康复

Diagnosis, treatment and rehabilitation of non-ossifying fibroma in long bones of children

目的探讨儿童长骨非骨化性纤维瘤(non-ossifying fibroma,NOF)的临床特点、诊治方法及康复预后。方法2006年8月至2017年10月共收集患儿26例,其中男18例,女8例。年龄1岁1个月至15岁。单发病灶23例,多发病灶3例,其中2例为Jaffe-Campanacci Syndrome。全部病例均受累于四肢长骨干骺部,23例单发病灶中,胫骨11例,股骨8例,腓骨2例,肱骨2例。3例多发病灶部位也在胫骨、股骨、腓骨和肱骨。24例经手术治疗,手术方式为单纯病灶清除术,病灶清除加自体骨、同种异体骨或人工骨移植术,以及在此基础上的接骨板螺钉或克氏针内固定术。2例未手术持续观察中。所有患儿均进行了康复指导。结果24例经临床、影像、病理证实为NOF,其中22例得到随访,随访时间6~72个月。另外2例根据临床特点及典型的X线片确诊为NOF,其中1例腓骨受累患儿,观察期间(随访第17个月时)病灶自然退变,消失自愈。结论因NOF发病率较低,至今认识不足,易导致误诊误治,诊断上应与其它骨肿瘤相鉴别。对发生于典型部位又无明显症状的少年儿童,加上典型的X线片表现,被多数学者公认不用病理检查也可确诊。对疑难或X线片表现不典型病例,临床、影像、病理三结合的综合分析才能做出正确诊断。NOF本质为良性骨肿瘤,预后良好,有明显自限,自愈倾向,除非有并发症,有碍患肢功能时可行手术治疗,但对本肿瘤而言,过多手术介入没有必要,甚至带来不良并发症。

Objective To investigate clinical features,diagnosis,treatment and rehabilitation prognosis of non-ossifying fibroma(NOF)in long bones of children.Methods A total of 26 cases were collected since 2006,including 18 males and 8 females.The age ranged 13 months to 15 years.There were 23 single lesions(11 in the tibia,8 in the femur,2 in the fibula,2 in the humerus)and 3 multifocal lesions(tibia,femur,fibula,humerus),among whom 2 were Jaffe-Campanacci Syndrome patients.All lesions located in the long bones of the extremities.Twenty-four patients underwent surgical treatment.Simple debridement,debridement plus bone grafting(autologous bone,allogenic bone or artificial bone),plate screw or Kirschner wire internal fixation were conducted.Two patients did not undergo any operations.All children were given rehabilitation instructions.Results Twenty-four patients were confirmed to be NOF by clinical,imaging and pathology examinations,and 22 of them were followed up for 6-72 months.Another 2 cases were diagnosed as NOF according to clinical features and typical X-ray photographs.One patient with tibia involvement was observed,but lesions naturally degenerated and disappeared during the observation(at the 17 th month of follow-up).Conclusions Misdiagnosis and mistreatment still exist due to the lack of comprehensive understanding.Meanwhile,it should be differentiated from other bone tumors.Most scholars have confirmed that it can be diagnosed without pathological examination,but symptoms,radiology and pathological findings should be combined to ensure correct diagnosis.It belongs to benign bone tumors,and has obvious selflimiting,self-healing tendency and good prognosis.Excessive surgical intervention is not necessary except for complications.