儿童骨嗜酸性肉芽肿的临床特点及诊治

目的分析儿童骨的嗜酸性肉芽肿的临床特点,探讨该病的诊治方法。方法2001年～2006年收治11例患儿,男6例,女5例,平均年龄4.5岁。发病部位:股骨下段、近端各1例,胫骨中上段6例,颈椎1例,胸椎1例,髂骨1例。病灶累及脊柱者行颈托或腰背支具固定保守治疗,其余皆行病灶刮除同种异体骨植骨术。结果全部病例随访6个月～5年,平均2年3个月,行手术的9例患者中8例恢复良好无复发,1例累及股骨颈者1年后X线片示残余低密度灶;非手术治疗者1年后复查X线片示椎体高度恢复至正常的2/3,无外观畸形。结论本病诊断应结合临床表现、体格检查、辅助检查(X线、CT、MRI、化验),手术前行局部穿刺活检明确病变性质,确诊依据病理学结果。该病诊断时需与孤立性骨囊肿等疾病相鉴别。对于负重部位的病灶应积极行手术治疗,对于无神经症状的脊柱病灶可行保守治疗。

The clinical features, diagnosis and treatment of eosinophilic granuloma of bone in children

Objective To evaluate the clinical features,diagnosis,treatment and prognosis of esinophilic granuloma in children.Methods from 2001 through 2006,11 children with eosinophilic granuloma were treated.The children were 6 boys and 5 girls with an average age of 5 years.The lesion distribution was as follows:tibia in 6 cases,femur in 2,illium in 1,cervical vertebrae in 1 and lumbar vertebrae in 1.The patients with vertebral involvement were treated by bracing.Results the time of follow-up ranged from 6 months to 5 years(2.3 years in average).Among the 9 patients undergoing surgery,8 cured with no recurrence and one demonstrated partial absorption of bone graft on radiogram 1 year after surgery.The patients treated by bracing showed restoration of the 2/3 normal height of vertebral body on radiograms.Conclusions The diagnosis of eosinophilic granuloma of bone depends upon clinical symptoms and the findings of physical examination,radiography,CT scan,MRI and laboratory tests.Needle biopsy would be necessary before surgery.Its final diagnosis relies on pathologic examination.Because of no specific manifestation of the disease,great attention should be paid to differentiate it from solitary bone cyst,subacute osteomylitis,Ewing s sarcoma and vertebral tuberculosis,in case of misdiagnosis.Surgery would be prefer-able for those patients with lesions in weight-bearing bones to accelerate their healing and prevent pathologic fracture.Nevertheless,conservative treatment would be feasible for these with lesion in vertebral column and no neurological compromise.