Mo Yueqiang,Song Jun,Wang Dahui.Treatments and outcomes of benign proximal femoral bone lesion with pathologic fracture in children[J].Journal of Clinical Pediatric Surgery,,19():586-589,595.[doi:10.3969/j.issn.1671-6353.2020.07.005]
Treatments and outcomes of benign proximal femoral bone lesion with pathologic fracture in children
- Keywords:
- Femoral Fractures; Fractures; Spontaneous; Treatment Outcome; Child
- CLC:
- R726.8;R683.42
- Abstract:
- Objective To explore the treatments and outcomes of benign proximal femoral bone disease with pathologic fracture in children.Methods Clinical data were retrospectively analyzed for 50 hospitalized children with benign proximal femoral bone lesions from June 2011 to June 2018.Pathologic fractures occurred in 14 children with an average age of 90 (69-155) months.And there were 10 boys and 4 girls.The involved side was left (n=8) and right (n=6).The causes were simple bone cysts (n=8) and fibrous dysplasia (n=6).Surgical strategies and internal fixations were selected according to the location,range and initial diagnosis of proximal femoral tumor and fracture.Results One child was lost to follow-up at 2 months after surgery.The remainders were followed up for an average of 43.5(20-98) months.The outcomes were complete healing (n=4),defect healing (n=3),persistent existence (n=5) and recurrence (n=1).The healing rate was 53.8%.The healing time of pathological fracture had an average range of 10.9(6-31) weeks.There were a premature closure of epiphyses (n=1),a limitation of hip joint movement (n=1) and coxa vara (n=2).There was no avascular necrosis of femoral head or failure of internal fixation.Conclusion For children with benign proximal femoral bone lesions accompanied by pathological fracture,tumor type,range of involvement and fracture site should be considered comprehensively.Individualized treatments should be offered to obtain satisfactory functional and imaging outcomes.
References:
1 李海冰,叶文松,徐璐杰,等.儿童股骨近端良性骨肿瘤的手术治疗策略探讨[J].临床小儿外科杂志,2020,19(3):241-247.DOI:10.3969/j.issn.1671-6353.2020.03.010. Li HB,Ye WS,Xu LJ,et al.Treatment strategies for proximal femoral benign bone lesions in children[J].J Clin Ped Sur,2020,19(3):241-247.DOI:10.3969/j.issn.1671-6353.2020.03.010.
2 George B,Abudu A,Grimer RJ,et al.The treatment of benign lesions of the proximal femur with non-vascularised autologous fibular strut grafts[J].J Bone Joint Surg Br,2008,90(5):648-651.DOI:10.1302/0301-620X.90B5.20330.
3 Angelini A,Trovarelli G,Berizzi A,et al.Treatment of pathologic fractures of the proximal femur[J].Injury,2018,49(3):S77-S83.DOI:10.1016/j.injury.2018.09.044.
4 Jeys LM,Suneja R,Chami G,et al.Impending fractures in giant cell tumours of the distal femur:incidence and outcome[J].Int Orthop,2006,30(2):135-138.DOI:10.1007/s00264-005-0061-z.
5 Erol B,Topkar MO,Aydemir AN,et al.A treatment strategy for proximal femoral benign bone lesions in children and recommended surgical procedures:retrospective analysis of 62 patients[J].Archives of Orthopaedic and Trauma Surgery,2016,136(8):1051-1061.DOI:10.1007/s00402-016-2486-9.
6 Enneking WF,Dunham W,Gebhardt MC,et al.A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system[J].Clin Orthop Relat Res,1993(286):241-246.
7 Chang CH,Stanton RP,Glutting J.Unicameral bone cysts treated by injection of bone marrow or methylprednisolone[J].J Bone Joint Surg Br,2002,84(3):407-412.DOI:10.1302/0301-620x.84b3.12115.
8 周颖,王波,楼跃,等.三种内固定方式治疗儿童移位型股骨颈骨折的临床分析[J].中华创伤杂志,2017,33(11):1016-1021.DOI:10.3760/cma.j.issn.1001-8050.2017.11.012. Zhou Y,Wang B,Lou Y,et al.Comparison of three internal fixation techniques for treating displaced femoral neck fractures in children[J].Chinese Journal of Trauma,2017,33(11):1016-1021.DOI:10.3760/cma.j.issn.1001-8050.2017.11.012.
9 Hajdu S,Schwendenwein E,Kaltenecker G,et al.The effect of drilling and screw fixation of the growth plate-an experimental study in rabbits[J].J Orthop Res,2011,29(12):1834-1839.10.1002/jor.21463.
10 Janarv PM,Wikstr?m B,Hirsch G.The influence of transphyseal drilling and tendon grafting on bone growth:an experimental study in rabbit[J].J Pediatr Orthop,1998,18(2):149-154.
11 Stanton RP,Ippolito E,Springfield D,et al.The surgical management of fibrous dysplasia of bone[J].Orphanet J Rare Dis.2012;7(Suppl 1):S1.DOI:10.1186/1750-1172-7-S1-S1.
12 Cohen J.Simple bone cysts.Studies of cyst fluid in six cases with a theory of pathogenesis[J].J Bone Joint Surg Am,1960,42-A:609-616.
13 Kim MC,Joo SD,Jung ST.The role of fractures on pathologic bone in healing of proximal humerus unicameral bone cysts[J].J Orthop Surg (Hong Kong),2018,26(2):2309499018778366.DOI:10.1177/2309499018778366.
14 刘继中,王臻,李明全,等.儿童股骨近端肿瘤合并病理骨折的手术治疗[J].中国矫形外科杂志,2001,8(7):633-636.DOI:10.3969/j.issn.1005-8478.2001.07.002. Liu JZ,Wang Z,Li MQ,et al.Surgical options for pathological fractures of proximal femur in children[J].Orthopedic Journal of China,2001,8(7):633-636.DOI:10.3969/j.issn.1005-8478.2001.07.002.
15 Cha SM,Shin HD,Kim KC,et al.Does fracture affect the healing time or frequency of recurrence in a simple bone cyst of the proximal femur?[J].Clin Orthop Relat Res,2014,472(10):3166-3176.DOI:10.1007/s11999-014-3768-6.
16 De Sanctis N,Andreacchio A.Elastic stable intramedullary nailing is the best treatment of unicameral bone cysts of the long bones in children? Prospective long-term follow-up study[J].J Pediatr Orthop,2006,26(4):520-525.DOI:10.1097/01.bpo.0000217729.39288.df.
17 Li J,Rai S,Ze R,et al.Injectable calcium sulfate vs mixed bone graft of autologous iliac bone and allogeneic bone:Which is the better bone graft material for unicameral bone cyst in humerus?[J].Medicine,2020,99(23):e20563.DOI:10.1097/MD.0000000000020563.
18 DiCaprio MR,Enneking WF.Fibrous dysplasia.Pathophysiology,evaluation,and treatment[J].J Bone Joint Surg Am,2005,87(8):1848-1864.DOI:10.2106/JBJS.D.02942.
Memo
收稿日期:2020-05-04。
基金项目:上海申康医院发展中心临床科技创新项目临床研究培育项目（编号：SHDC12019X28）
通讯作者:王达辉,Email:wangdahui@fudan.edu.cn