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目的总结儿童长骨嗜酸性肉芽肿(eosinophilic granuloma,EG)的手术方法及临床疗效。方法 2005年1月-2009年12月,收治14例长骨EG患儿。男9例,女5例;年龄1～13岁,平均6.5岁。股骨5例,肱骨4例,胫骨2例,腓骨1例,股骨并发胫骨2例。病程7 d～10个月,中位病程2个月。X线片检查见边界清楚的溶骨性破坏,但未累及骺板。12例采用肿瘤病灶刮除、自体髂骨或联合人工骨植骨修复,2例瘤段切除、自体髂骨重建、钢板螺钉固定治疗。5例伴病理性骨折均同期行骨折复位固定。结果病理检查均确诊为EG。术后切口均Ⅰ期愈合。12例获随访,随访时间1～4年,平均2年。X线片示肿瘤病灶及病理性骨折均愈合,愈合时间3～4个月,平均3.5个月。1例股骨EG术后8个月再次发现胫骨病灶,再手术后愈合;余11例未见局部复发。根据X线片及关节功能综合评价标准,均为优。结论 儿童长骨EG多见于股骨及肱骨,肿瘤病灶刮除、自体髂骨或人工骨植骨修复是有效方法之一,术后预后良好,但病变有多发可能,需长期随访观察。
Objective To summarize the surgical methods and clinical efficacy of eosinophilic granuloma (EG) in children. Methods From January 2005 to December 2009, 14 children with long bone EG were treated. 9 males and 5 females; aged 1 to 13 years old, with an average of 6.5 years old. 5 cases of femur, 4 cases of humerus, 2 cases of tibia, 1 case of fibula and 2 cases of femur complicated with tibia. Duration of 7 d ~ 10 months, the median duration of 2 months. X-ray examination showed a clear border osteolytic destruction, but did not affect the epiphyseal plate. Twelve cases were treated with tumor lesion curettage, autologous ilium or artificial bone graft, 2 tumor resection, autologous iliac bone reconstruction and plate fixation. Five cases with pathological fractures were fracture reduction and fixation at the same period. Results The pathological examination was confirmed as EG. Postoperative incision healed first. 12 cases were followed up for 1 to 4 years, an average of 2 years. X-ray showed tumor lesions and pathological fractures were healed, healing time 3 to 4 months, an average of 3.5 months. A case of femur EG again found tibial lesions 8 months after operation and healed again after surgery. No local recurrence was found in the other 11 cases. According to X-ray and joint function evaluation criteria, are excellent. Conclusion Long bone EG is more common in the femur and humerus. Scratch removal of tumor lesion and autogenous iliac or artificial bone graft are one of the effective methods. The postoperative prognosis is good, but the lesions are likely to occur and need long-term follow-up observation.