Heneghan Mallorie B, Rheingold Susan R, Li Yimei, Seif Alix E, Huang Yuan-Shung, McLeod Lisa, Wells Lawrence, Fisher Brian T, Aplenc Richard
Department of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA.
Department of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA.
Clin Lymphoma Myeloma Leuk. 2016 Apr;16(4):223-229.e2. doi: 10.1016/j.clml.2015.12.009. Epub 2016 Jan 4.
Cure rates for acute lymphoblastic leukemia (ALL) have improved, but as therapy has intensified, the burden of osteonecrosis (ON) has increased. Limited data exist regarding surgical interventions for pediatric ALL patients with ON.
A multi-center cohort of children with newly diagnosed ALL was established with Pediatric Health Information System (PHIS) data from 43 freestanding children's hospitals from 1999 to 2011. Patients with ON identified by International Classification of Diseases, Ninth Revision (ICD-9) code were followed for up to 5 years after index ALL admission for the presence of ON-associated orthopedic surgical procedures.
A cohort of 10,729 ALL patients was assembled, of which 242 (2.33%) were identified with an ICD-9 code for ON within 5 years of ALL diagnosis. Fifty-five patients (22.7%) with ON underwent orthopedic surgical intervention aimed at joint preservation (82%) or replacement (18%) with substantial practice variation by hospital in both the rate and type of surgical intervention. The majority of patients had surgical procedures while receiving maintenance therapy. None of the patients undergoing surgical intervention required intensive care unit-level care within 14 days of surgery, and there was no associated in-hospital mortality.
No standard of care exists for treatment of ALL-associated ON. While considerable practice variation exists, surgical intervention appears relatively safe.
急性淋巴细胞白血病（ALL）的治愈率有所提高，但随着治疗强度的增加，骨坏死（ON）的负担也随之加重。关于小儿ALL合并ON患者手术干预的数据有限。
利用1999年至2011年43家独立儿童医院的儿科健康信息系统（PHIS）数据，建立了一个新诊断ALL患儿的多中心队列。通过国际疾病分类第九版（ICD-9）编码确定的ON患者，在首次ALL入院后随访长达5年，观察是否存在与ON相关的骨科手术。
共纳入10729例ALL患者，其中242例（2.33%）在ALL诊断后5年内被ICD-9编码确诊为ON。55例（22.7%）ON患者接受了旨在保留关节（82%）或置换关节（18%）的骨科手术干预，不同医院在手术干预的发生率和类型上存在很大差异。大多数患者在接受维持治疗时接受了手术。接受手术干预的患者在术后14天内均无需重症监护病房级别的护理，且无院内死亡相关情况。
ALL相关ON的治疗尚无标准治疗方案。虽然存在很大的实践差异，但手术干预似乎相对安全。
