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目的观察骨水泥填充治疗难以应用植骨的小儿骨病变的疗效及分析。方法 2012年5月至2016年5月期间我院收治进行骨水泥填充治疗骨病变10例(11处)。其中男8例,女2例,年龄2~15岁,平均8.2岁;感染性病变7例(骨结核4例、非特异型感染3例)、肿瘤及肿瘤样病变3例(软骨母细胞瘤2例、骨纤维结构不良1例);股骨5例、胫骨3例、尺骨1例、髂骨1例、髋臼1例。手术中先对病灶取活检,冰冻病理提示病变为感染或无法植骨的肿瘤后,对病灶彻底清创,以骨水泥填充骨缺损区,1例同时使用外固定架和髓内钉固定。术后石膏固定6~12周,目前术后骨水泥尚未取出。结果随访时间6~36个月,平均22.4个月。随访患儿中,感染或肿瘤性病变均无复发,无疼痛,无病理性骨折发生。累及下肢骨患儿,均恢复完全负重。受累关节活动度得到改善。1例慢性骨髓炎患儿因病灶完全破坏胫骨远端骨骺,术后1年出现胫骨短缩、踝内翻,余患儿受累骨力线良好。结论骨水泥对小儿骨感染病变和无法植骨的肿瘤性病变进行填充治疗的疗效显著,可有效地缓解患者的临床症状,降低其病情的复发率。该方法为难治性儿童骨病变提供了一种良好的治疗选择。
Objective To observe the effect and analysis of bone cement filling in the treatment of pediatric bone disease which is difficult to apply. Methods From May 2012 to May 2016, 10 cases (11 sites) were treated with bone cement filling in our hospital. There were 8 males and 2 females, aged 2-15 years (average 8.2 years). Infectious lesions were found in 7 cases (4 cases of tuberculosis and 3 cases of nonspecific infection), 3 cases of tumor and tumor-like lesions (chondroblastoma 2 cases, 1 case of fibrous dysplasia); 5 cases of femur, 3 cases of tibia, 1 case of ulna, 1 case of ilium and 1 case of acetabulum. Surgical biopsy of the lesion, frozen pathology prompted the lesion infection or non-bone tumor, the complete debridement of the lesion, bone cement filled with bone defect area, 1 case of both external fixators and intramedullary nail fixation. Postoperative gypsum fixed 6 to 12 weeks, the current postoperative bone cement has not been removed. Results The follow-up time ranged from 6 to 36 months with an average of 22.4 months. Follow-up in children, no recurrence of infection or tumor lesions, no pain, no pathological fracture occurred. Involved in lower limb bone children, were completely restored weight. Affected joint activity improved. One patient with chronic osteomyelitis completely destroyed the distal epiphysis of the tibia due to the lesion. One year after operation, the tibial shortening and ankle varus occurred, and the rest of the children had good bone strength. Conclusion The treatment of bone cement in children with bone-borne diseases and non-bone-setting tumor lesions is significant. It can effectively relieve the clinical symptoms and reduce the recurrence rate of the patients. This method provides a good treatment option for refractory childhood bone lesions.