骨囊肿的激素治疗效果评价

目的研究总结甲泼尼龙病灶内注射治疗不同部位骨囊肿的疗效。方法2007年5月至2012年7月，治疗有完整资料的骨囊肿病例33例，男23例，女10例；平均年龄12.3（5～28）岁，接受加强龙囊内注射治疗。随访3～53个月，平均31.3个月。病灶位于股骨近端10例，股骨干1例，腓骨远端1例，髂骨2例，肱骨近端19例。治疗前有病理骨折11例，制动1～2个月待骨折愈合后接受治疗。治疗前4例接受病灶刮除植骨术后复发，其中2例行刮除植骨钢板内固定。所有病例治疗前均常规进行穿刺活检，证实为骨囊肿后，进行激素治疗。治疗前采用静脉全麻，在“C”型臂下病灶两端插入骨穿针2枚，搔刮病灶骨壁，破坏囊肿纤维膜，用生理盐水反复冲洗病灶后注入造影剂，显示病灶充盈良好后冲去造影剂，根据囊腔的大小注入100～200mg甲泼尼龙溶液。按压穿刺针孔3min，防止激素渗出，加压包扎伤口。结果30例患者接受2～4次不等激素注射，平均2.5次，间隔1～3个月不等，术后每隔1个月拍片复查，根据NeerClassification评估标准，完全愈合及部分愈合27例（81.8％），治疗无效4例，其中2例接受刮除植骨术后囊肿愈合，1例接受刮除骨水泥填充DHS内固定，1例未继续治疗。囊肿愈合后复发3例，均改行手术治疗术后囊肿愈合。4例术后复发患者中，1例经过3次激素治疗后无效再次行刮除植骨术，囊肿愈合；2例经过2～3次注射治疗，病灶达到部分愈合；1例3次激素注射后，囊肿部分愈合后再次复发，终止治疗。治疗前11例合并病理骨折患者，待骨折愈合后再进行激素治疗后，2例经过2～3次注射治疗无效改行手术治疗，其他9例分别达到完全愈合及部分愈合。结论单纯性骨囊肿行激素注射治疗是有效的治疗手段。约80％左右患者可以避免手术治疗，达到治愈。相对其它治疗方法，此方法操作简单，损伤小，可以作为治疗单纯骨囊肿的首选方法。

Results evaluation of hormone therapy of the bone cysts

Objective To study and summarize the curative effects of intralesional injection of methylprednisolone for the treatment of the bone cysts in different parts of the body. Methods 33 patients with bone cysts of intact data were adopted from May 2007 to July 2012, who were treated with intracapsular injection of methylprednisolone. There were 23 males and 10 females, whose mean age was 12.3 years old （ range;5-28 years ）. All patients were followed up for a mean period of 31.3 months （ range;3-53 months ）. The lesions of 10 cases were situated in the proximal femur, 1 case in the shaft of femur, 1 case in the distal ifbula, 2 cases in the ilium and 19 cases in the proximal humerus. 11 patients with pathological fractures were immobilized for 1-2 months, who received treatment when the fractures were healed. Before the treatment, 4 patients who were treated with curettage and bone graft reoccurred postoperatively. 2 of them were treated with curettage, bone graft and internal ifxation with steel plates. Before the treatment, routine aspiration biopsy was performed on all the patients, and hormone therapy was carried out when bone cysts were conifrmed. Before the treatment, venous general anesthesia was used. Under the guide of“C”-arm, 2 medullo-puncture needles were introduced into both sides of the lesions to scrape the bone wall and destroy the cyst membrane. The lesions were repeatedly washed by normal saline, and contrast medium was injected. When the lesions were in good comditions, contrast medium would be rushed. The volume of 100-200 mg methylprednisolone was determined by the size of the cystic cavity. The puncture needle was pressed for 3 minutes to prevent the hormonal exudation and compress the wound bandage. Results 30 patients were injected with different amounts of hormones for a mean of 2.5 times （ range;2-4 times ）, and the interval time was 1-3 months. Postoperatively X-rays were reviewed every 2 months. According to the Neer classiifcation：27 patients （ 81.8%） were completely healed, 27 patients （ 81.8%） were healed with defects, and 4 patients had ineffective treatment. Among them, 2 patients had cysts healed after curettage and bone graft, and 1 patient received curettage, bone cement iflling and dynamic hip screw （ DHS ） internal ifxation. The treatment was terminated for 1 patient. 3 patients who had recurrence after cyst union accepted surgical treatment, whose cysts got healed postoperatively. 1 of the 4 patients who had postoperative recurrence received curettage and bone graft after the failure of hormone therapy for 3 times, and the cysts also got healed. 2 patients had lesions partially healed after infection therapy for 2-3 times. Another recurrence occurred to 1 patient who had cysts partially healed after hormone therapy for 3 times, and then the treatment was terminated. Among the 11 patients with pathological fractures who had hormone therapy after fracture union, 2 patients had surgical treatment after the failure of infection therapy for 2-3 times, and the other 9 patients had complete union or particle union. Conclusions It is an effective method to treat simple bone cysts with hormone infection. About 80%of patients can avoid surgical treatment, and got healed. Comparing with other treatment, it is the preferred method of treating simple bone cysts, with easy operation procedures and small trauma.