Kucera T, Krajina A, Sponer P, Kohout A
Ortopedická klinika FN a LF UK Hradec Králové.
Acta Chir Orthop Traumatol Cech. 2006 Apr;73(2):99-103.
This study on vascular malformations of the musculoskeletal system in children is concerned with the disease diagnosis and evaluation of treatment results in a group of pediatric patients.
Eighteen children with musculoskeletal vascular malformations, treated at the Department of Orthopedics in Hradec Králové, were assessed. The relevant data were obtained from their medical notes and the children were examined at the outpatient department.
The initial complaints leading to examination at our department, diagnostic methods used and outcomes of vascular malformation treatment were investigated. Special attention was paid to the results of treatment for unequal leg length.
The most frequent initial complaint was a painful, growing, hard tissue mass on either an upper or a lower extremity. In addition to clinical and angiographic diagnostic methods, also Doppler sonography and magnetic resonance imaging were used. Therapy by intervention radiology (selective embolization or sclerotherapy) resulted in reduction of the lesion and subsidence of the signs in 76 % of the patients. In the rest (24 %), the clinical findings did not change. It was necessary to repeat these methods twice to four-times. The best results were achieved by combining intervention radiology and a subsequent excision of the malformation. Of the four patients, only one experienced recurrence after 11 years. Four children were successfully treated for unequal leg length by temporary epiphyseodesis of the proximal tibia which, in one, had to be completed with shortening osteotomy of the proximal femur performed after skeletal maturation.
There is great inconsistency in the classification of vascular malformations as well as in views on their therapy. The increasing role of magnetic resonance imaging for the diagnosis of vascular malformations is apparent, and our results fully support this fact. Intervention radiology techniques still remain the prevailing methods of treatment. In our experience, the best results are achieved by their combination with an excision of the lesion. When unequal leg length is treated, temporary epiphyseodesis is recommended; if this is preceded by treatment of the malformation, the final discrepancy in leg length is smaller.
The correct diagnosis and treatment of vascular malformations and their sequelae are based on inter-disciplinary cooperation. The use of magnetic resonance imaging for diagnosis is recommended. Good results are achieved by a combination of intervention radiology methods with lesion excision. Temporary epiphyseodesis is the method of choice for treatment of unequal leg length.
本项关于儿童肌肉骨骼系统血管畸形的研究关注一组儿科患者的疾病诊断及治疗效果评估。
对在赫拉德茨克拉洛韦骨科接受治疗的18例患有肌肉骨骼血管畸形的儿童进行了评估。相关数据取自他们的病历，并在门诊部对这些儿童进行了检查。
调查了导致到我院就诊的初始症状、所采用的诊断方法以及血管畸形的治疗结果。特别关注了双下肢不等长的治疗结果。
最常见的初始症状是上肢或下肢出现疼痛、不断增大的硬性组织肿块。除临床和血管造影诊断方法外，还使用了多普勒超声和磁共振成像。介入放射治疗（选择性栓塞或硬化治疗）使76%的患者病变缩小且症状消退。其余患者（24%）临床症状未改变。有必要将这些方法重复两到四次。通过将介入放射治疗与随后的畸形切除术相结合取得了最佳效果。4例患者中，只有1例在11年后复发。4例双下肢不等长的儿童通过临时胫骨近端骨骺阻滞术成功治愈，其中1例在骨骼成熟后还需进行股骨近端缩短截骨术以完成治疗。
血管畸形的分类以及对其治疗的观点存在很大不一致。磁共振成像在血管畸形诊断中的作用日益明显，我们的结果充分支持这一事实。介入放射技术仍然是主要的治疗方法。根据我们的经验，将其与病变切除术相结合可取得最佳效果。治疗双下肢不等长时，建议采用临时骨骺阻滞术；如果在此之前先治疗畸形，则双下肢最终的长度差异会更小。
血管畸形及其后遗症的正确诊断和治疗基于多学科合作。建议使用磁共振成像进行诊断。将介入放射治疗方法与病变切除术相结合可取得良好效果。临时骨骺阻滞术是治疗双下肢不等长的首选方法。
