儿童血液系统恶性肿瘤化疗后发生骨坏死的临床研究

目的 对儿童血液系统恶性肿瘤化疗后导致骨坏死进行危险因素分析.方法 回顾性分析2005年6月至2010年6月在我院住院治疗105例血液系统恶性肿瘤患儿(包括急性淋巴细胞白血病、急性髓系白血病和非霍奇金淋巴瘤).男55例,女50例,年龄1.6～17.8岁,平均8.25岁,对患儿治疗过程和随访情况进行临床观察和记录,统计患儿接受的化疗方案,发生骨坏死的比例,部位,针对骨坏死治疗方法和预后.结果 10例患儿发生了骨坏死,男5例,女5例,发病年龄9.8～16.8岁,平均14.4岁,发生骨坏死的平均年龄大于未发生骨坏死的平均年龄(P＜0.05).接受化疗时间平均10.8个月(8～49个月),发生骨坏死的部位共有16个部位,其中14个发生在股骨头.接受激素治疗剂量为折合强的松4 425～9 599 mg,平均5 967 mg.95例患儿未发生骨坏死,年龄1.6～17.8岁,平均7.2岁,接受强的松的剂量为0～18 585 mg,平均3 943 mg.骨坏死的发生与激素的摄入量比较,有统计学差异(P＜0.05).发生骨坏死与性别无统计学差异(P＜0.05).结论 儿童血液系统恶性肿瘤化疗后造成的骨坏死多发生在负重关节,与激素摄入量、年龄密切相关,与性别无关.

Occurrence of osteonecrosis after chemotherapy for hematological malignancies in childhood

Objective To explore the major causative factors of osteonecrosis (ON) after chemotherapy for hematological malignancies in childhood.Metlods We reviewed retrospectively the medical records of 105 patients with hematological malignancies of acute lymphoblastic leukemia,acute myeloid leukemia and T-cell non-Hodgkin lymphoma from June 2005 to June 2010.They were 55 boys and 50 girls with an average age of 8.25 (1.6-17.8) years.Logistic regression was used for examining the relationship between risk factors and incidence of ON,sites,therapeutic modalities and prognosis.Results Ten children developed ON after a mean time of 10.8 months.There were 5 boys and 5 girls with a mean age of 14.4 (9.8-16.8) years.Among 16 involved sites,14 were located in femoral head.All these children were older than those not developing ON (9.8-16.8 vs.1.6-17.8 years).The mean course of therapy was 10.8 (8-49) months.All received steroids.with a mean accumulative dose of 5 967 (4 425-9 599) mg versus 3 943 (0-18 585) mg for those without ON (P＜0.05).No difference existed between genders.Conclusions ON affects frequently weight-bearing epiphyses.And its risks increase with age and higher steroid doses,but not gender.