弹性髓内钉内固定在儿童肱骨溶骨性病变中的应用研究

Fixation of humeral osteolytic lesions in children with elastic intramedullary nails

目的探讨弹性髓内钉在儿童肱骨溶骨性病变中的应用效果。方法回顾性分析上海交通大学附属儿童医院2013年至2018年收治的18例肱骨溶骨性病变患者临床资料。所有患者均行刮除植骨联合电刀磨钻并辅以弹性髓内钉内固术,根据病灶愈合标准、Mirels评分及美国骨肿瘤学会评分系统(MSTS)评分评价预后情况。结果所有患者术后均随访18个月以上。根据病灶愈合标准,病灶复发3例,持续存在1例,缺损愈合2例,病灶愈合12例;Mirels评分8分3例,7分1例,6分2例,0分12例;术前MSTS评分4~8分,平均6分,术后MSTS评分22~30分,平均28分,手术前后MSTS评分差异有统计学意义(t=18.044,P=0.0043)。结论对于儿童肱骨溶骨性病变,弹性髓内钉内固定是一种安全、有效的辅助措施,它可以提高术后肢体功能,有效降低病变复发后病理性骨折发生风险。

Objective To summarize the diagnosis and treatment of osteolytic lesions of humerus in children.Methods Retrospective analysis of 18 cases of humeral osteolytic lesions in children was conducted.All were treated with curettage and bone grafting combined with elastic intramedullary nailing in Shanghai Children’s Hospital from2013 to 2018.The outcomes were evaluated according to the lesion healing criteria,the Musculoskeletal Tumor Society(MSTS)scores and Mirels scores.Results All the patients were followed up for more than 18 months.Recurrence was observed in 3 cases,persistent lesion in 1 case,defect in 2 cases and cure in 12 cases.According to the postoperative Mirels scores,3 cases obtained 8 scores,1 case 7 scores,2 cases 6 scores,12 cases 0 score.The preoperative MSTS scores ranged from4 to 8,with an average of 6;the postoperative MSTS scores ranged from22 to 30,with an average of 28,with statistically significant difference compared with that preoperatively(t=18.044,P<0.01).Conclusion Elastic intramedullary nailing is safe and effective fixation of humeral osteolytic lesions in children,due to the improvement of postoperative function and reduction of pathological fractures following recurrence.