Riccio Ilaria, Pota Elvira, Marcarelli Marco, Affinita Maria Carmen, Di Pinto Daniela, Indolfi Cristiana, Del Regno Nicola, Esposito Marco
Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples.
Pediatr Med Chir. 2016 Nov 28;38(3):118. doi: 10.4081/pmc.2016.118.
Osteonecrosis is a significant adverse effect of treatment administered to children suffering from acute lymphoblastic leukemia (ALL) that may have a negative effect on the quality of life. The purpose of this study is to evaluate the rate of secondary vascular osteonecrosis (ON) in a population of pediatric patients with ALL treated with corticosteroids and cytostatic agents. A retrospective analysis of prospectively collected data of the medical records of 328 patients with ALL identified 4 cases with ON, corresponding to 1.2% of all cases observed. Of the 4 patients identified in our study 3 were girls and 1 was a boy, aged from 10 to 16 years old (average age at diagnosis, 12 years). Median time between the diagnosis of ALL and ON was 12.5 months (range, 12 to 36 months). Regarding the lesion size of ON, in all cases the femoral head (monolateral in 1 case and bilateral in 3 cases) was involved and was associated with the scapula-humeral joint in one case. ON of the weight-bearing joints has been identified as a severe complication in children with leukemia that may be associated with the development of articular surface collapse, subsequent debilitating arthritis, sometimes needing arthroplasty. For this reason it is very important to implement prevention strategies, especially in adolescent girls treated with steroids and chemotherapy. An early diagnosis of ON and careful orthopedic follow-up are necessary in order to avoid bone deformations related to the late start or the wrong therapy.
骨坏死是急性淋巴细胞白血病（ALL）患儿治疗过程中的一种严重不良反应，可能会对生活质量产生负面影响。本研究的目的是评估接受皮质类固醇和细胞毒性药物治疗的ALL儿科患者群体中继发性血管性骨坏死（ON）的发生率。对328例ALL患者病历中前瞻性收集的数据进行回顾性分析，发现4例ON病例，占所有观察病例的1.2%。在我们研究中确定的4例患者中，3例为女孩，1例为男孩，年龄在10至16岁之间（诊断时的平均年龄为12岁）。ALL诊断与ON之间的中位时间为12.5个月（范围为12至36个月）。关于ON的病变大小，所有病例均累及股骨头（1例为单侧，3例为双侧），1例与肩胛肱关节有关。负重关节的ON已被确定为白血病患儿的一种严重并发症，可能与关节面塌陷、随后的致残性关节炎有关，有时需要进行关节置换术。因此，实施预防策略非常重要，尤其是在接受类固醇和化疗的青春期女孩中。为了避免因治疗开始过晚或治疗错误而导致的骨骼畸形，ON的早期诊断和仔细的骨科随访是必要的。
