<div>儿童单纯性骨囊肿五种治疗方法的疗效比较</div>

彭湛; 张科学; 周辉霞; 张洪钿; 谢惠敏; 李军; 谢园园; 张天蕾; 刘丽; 陈继营

doi:10.12435/j.issn.2095-5227.24110701

儿童单纯性骨囊肿五种治疗方法的疗效比较

Comparison of effects of five treatment methods for simple bone cysts in children

摘要

摘要:
背景　单纯性骨囊肿是一种儿童常见的良性骨肿瘤，针对该病的临床实践存在很大差异，常用的治疗方法有病灶刮除后植骨、激素注射、自体骨髓血注射、弹性髓内针内固定等，目前缺乏对上述治疗方法的综合疗效评估研究。目的评估临床常用的五种治疗方法：刮除植骨、激素注射、自体骨髓血注射、弹性髓内针内固定和自体骨髓血注射联合弹性髓内针内固定在儿童单纯性骨囊肿治疗中的疗效。方法　回顾性分析解放军总医院2010年1月至2020年12月接受五种治疗方法的单纯性骨囊肿患儿临床资料，全部病例均行X线检查，必要时加做CT或MRI检查及病理检查。术后对患儿行X线随访，使用Capanna骨囊肿评价标准评价疗效。对治愈率、有效率、复发情况、住院次数及治愈时间等行组间比较。结果共纳入174例患儿，全部完成随访，其中男118例，女56例，年龄(8.2±2.8)岁，刮除植骨组31例，激素注射组32例，自体骨髓血注射组32例，弹性髓内针内固定组37例，自体骨髓血注射联合弹性髓内针固定组42例，组间性别和年龄差异无统计学意义(P＞0.05)。刮除植骨、激素注射、自体骨髓血注射、弹性髓内针内固定和自体骨髓血注射联合弹性髓内针内固定的治疗有效率分别为71.0%、75.0%、65.6%、86.5%、97.6%，自体骨髓血注射联合弹性髓内针固定组治疗有效率显著高于刮除植骨组与自体骨髓血注射组(P＜0.05)；复发率分别为29.0%、21.9%、28.1%、10.8%、2.4%，自体骨髓血注射联合弹性髓内针固定组复发率显著低于刮除植骨组与自体骨髓血注射组(P＜0.05)；治愈率分别为58.1%、56.2%、46.9%、81.1%、 92.9%，自体骨髓血注射联合弹性髓内针固定组治愈率显著高于刮除植骨组、激素注射组及自体骨髓血注射组(P＜0.05)；治愈时间分别为25(19.75，29)月、28.5(22.75，34)月、27(21，31)月、22(19，23)月、28(24，34)月，弹性髓内针内固定组治愈时间显著低于激素注射组及自体骨髓血注射联合弹性髓内针固定组(P＜0.05)；住院次数分别为2(1，2)次、4(3，5)次、 5(4，7)次、2(2，2)次、4(3，6.25)次，刮除植骨组与弹性髓内针内固定组住院次数均显著低于激素注射组、自体骨髓血注射组及自体骨髓血注射联合弹性髓内针固定组(P＜0.05)。结论　与单种治疗方法相比，自体骨髓血注射联合弹性髓内针固定的疗效最佳，治疗有效率及治愈率最高，值得临床推广应用。

Abstract: Background Simple bone cysts are common benign bone tumors in children, with significant variations in clinical practice for their treatment. Common therapeutic methods include curettage with bone grafting, steroid injection, autologous bone marrow injection, and elastic intramedullary nail fixation. Currently, comprehensive evaluations of these treatments are lacking. Objective To evaluate the effects of five commonly used treatment methods: curettage with bone grafting, steroid injection, autologous bone marrow injection, elastic intramedullary nail fixation, and combination of autologous bone marrow injection with elastic intramedullary nail fixation in treating unicameral bone cysts in children.Methods A retrospective analysis was conducted on children with simple bone cysts who underwent one of the five treatment methods from January 2010 to December 2020. All cases were assessed with X-ray examinations, and CT or MRI scans and pathological examinations were performed when necessary. Postoperative follow-up included X-ray evaluations, using the Capanna bone cyst assessment criteria to evaluate treatment outcomes. Outcomes including cure rate, treatment efficacy, recurrence, hospitalizations, and cure duration were compared across groups. Results All 174 patients (118 males, 56 females; mean age 8.2±2.8 years) completed follow-up. Treatment groups comprised curettage with bone grafting (n=31), steroid injection (n=32), autologous bone marrow blood injection (n=32), elastic intramedullary nail fixation (n=37), and combination of autologous bone marrow injection with elastic intramedullary nail fixation (n =42), with no significant intergroup differences in gender or age (P＞0.05). Treatment efficacy rates of the five groups were 71.0%, 75.0%, 65.6%, 86.5%, and 97.6%, respectively. Combination of autologous bone marrow injection with elastic intramedullary nail fixation showed significantly higher efficacy than curettage with bone grafting and autologous bone marrow injection (P＜0.05). Recurrence rates were 29.0%, 21.9%, 28.1%, 10.8%, and 2.4%, respectively. Combination of autologous bone marrow injection with elastic intramedullary nail fixation exhibited significantly lower recurrence than curettage with bone grafting and autologous bone marrow injection (P＜0.05). Cure rates were 58.1%, 56.2%, 46.9%, 81.1%, and 92.9%, respectively. Combination of autologous bone marrow injection with elastic intramedullary nail fixation achieved significantly higher cure rates than curettage, steroid injection, and autologous bone marrow injection (P＜0.05). Cure durations were 25 (19.75, 29) months, 28.5 (22.75, 34) months, 27 (21, 31) months, 22 (19, 23) months, and 28 (24, 34) months, respectively. Elastic intramedullary nail fixation had significantly shorter cure duration than steroid injection and combination of autologous bone marrow injection with elastic intramedullary nail fixation (P＜0.05). Number of hospitalizations was 2 (1, 2), 4 (3, 5), 5 (4, 7), 2 (2, 2), and 4 (3, 6.25), respectively. Curettage with bone grafting and elastic intramedullary nail fixation required significantly fewer hospitalizations than steroid injection, autologous bone marrow injection, and combination of autologous bone marrow injection with elastic intramedullary nail fixation (P＜0.05). Conclusion Compared to single treatment methods, combination of autologous bone marrow injection with elastic intramedullary nail fixation shows the best efficacy, with the highest efficacy and cure rates, and is worthy of clinical promotion and application.

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