儿童骨嗜酸性肉芽肿

Eosinophilic Granuloma of Bone in Children

目的提高对骨嗜酸性肉芽肿的诊断及治疗水平,减少误诊。方法回顾性分析了1997年～2001年间收治的29例骨嗜酸性肉芽肿的影像学资料、临床资料及随访结果。行手术刮除病灶及植骨术治疗17例,仅作病灶活检术的5例,非手术治疗7例。结果29例中初诊仅9例为骨嗜酸性肉芽肿,8例为骨病变待诊入院,有12例均诊断为其它疾病。手术治疗的17例中11例痊愈,随访2～5年无复发,3例有残余低密度灶,2例有骨骼的畸形愈合,1例疗效差并已失随访;作病灶活检术的5例中3例痊愈,2例病灶仍有待观察后必要时手术治疗。非手术治疗的7例中2例治愈,4例病灶明显缩小,症状消失,1例放弃治疗。结论儿童骨嗜酸性肉芽肿的X线表现多样,容易与其它病变混淆而引致误诊或漏诊,X线平片是发现骨破坏病灶和随访嗜酸性肉芽肿的首选和主要的检查方法,强调与临床、病理结合才能提高本病的诊断准确率。治疗上以手术刮除病灶及植骨为佳,在作活检术时尽可能刮除所有病变组织,避免二次手术。

Objective To improve the diagnosis and treatment of the eosinophilic granuloma of bone in children,and decrease the rate of misdiagnosis.Methods Twenty-nine children with eosinophilic granuloma of bone from1997to2001were admitted,their medical records and films were reviewed,and they were all followed up for2～5years.All of29cases,curettement and allograft were performed in17cases,biopsy was taken in5cases,and conservative treatment was performed in7cases.Results All of29cases,preliminary diagnosis was eosinophilic granuloma of bone in only9cases,osteopathia to be defined in8cases,another diagnosis in other12cases.At the last followed-up after2to5years,11cases fully recovered in17cases with operation,remnant lesion was left in3cases,deformaty union of the bone was occurred in2cases,1cases loss of the follow-up.In the5cases operation for biopsy3cases fully recovered,2cases needed to be observed.In7cases with conservative management 2cases cured,lesion decreased in4cases with the symptom obliteration,1cases abducted the treatment.Conclusions Eosinophilic granuloma of bone is not rare in children.In some cases the structure of bone was destroyed,which leads to worse prognosis.The manifestations of eosinophilic granuloma of bone in X-ray film are diverse.Although X -ray is a capital way in detecting the lesion and the follow -up,misdiagnosis or missed diagnosis may be occur using the X-ray only.When the X-ray film,clinical manifestations and pathologic result are comprehensive analyzed,the correct diagnosis may be defined.Curettement and bone graft is the best way for eosinophilic granuloma of bone.When have done with biopsy,the lesion should be curetted as clearly as possible in order to avoid a second operation.