青少年急性淋巴细胞白血病治疗后多发性骨坏死（附1例）

目的：报告1例急性淋巴细胞白血病（ALL）青少年治疗后并发多发性骨坏死及其治疗,并复习相关文献。方法：1例15岁的青少年ALL接受了BFM方案化疗,皮质激素（泼尼松和地塞米松,并将地塞米松换算为泼尼松的等效剂量）的累积剂量为7876mg/m2。结果：治疗结束后6个患者出现肩关节和髋关节骨坏死。ALL诊断和骨坏死诊断的相隔时间为41个月。病人有长期疼痛和活动受限。已建议行手术治疗。结论：接受强烈ALL化疗的青少年是发生ON的高危人群,未来的研究应在保证疾病控制的前提下,尽量减少治疗相关ON的发生。

Multifocal osteonecrosis as a complication of treating acute lymphoblastic leukemia in adolescent

Objective：To describe a case of multifocal osteonecrosis and its treatment in an aldolescent with acute lymphoblastic leukemia（ALL） and to review the literature.Methods：A case of 15-year-old adolecscent with ALL received the treatment of BFM protocol.Cumulative dose of corticosteroid,i.e.prednisone and dexamethasone,calculated as prednisone equivalent,was 7876mg/m2.Results：The patient developed symptomatic shoulder and femoral head osteonecrosis（ON） had chronic pain symptoms and immobility 6 months after ending of chemotherapy.The interval between the diagnosis of ALL and the diagnosis of ON was 41 months.Orthopedic surgical procedures had been suggested at the time of reporting.Conclusion：The adolescent who receive intensive ALL therapy,including multiple courses of corticosteroid,are at significant risk for developing ON.Future studies should attempt to minimize corticosteroid-associated bony morbidity without compromising clinical efficacy.