Li Haibing,Ye Wensong,Xu Lujie,et al.Treatment strategies for proximal femoral benign bone lesions in children[J].Journal of Clinical Pediatric Surgery,2020,19(03):241-247.[doi:10.3969/j.issn.1671-6353.2020.03.010]
儿童股骨近端良性骨肿瘤的手术治疗策略探讨
- Title:
- Treatment strategies for proximal femoral benign bone lesions in children
- Keywords:
- Femoral Neoplasms/SU; Proximal Femur; Fractures; Spontaneous; Child
- 分类号:
- R726.8;R739.96;R683.4
- 摘要:
- 目的 探讨儿童股骨近端良性骨肿瘤的手术治疗策略。方法 回顾性分析浙江大学医学院附属儿童医院2010年1月至2016年12月收治的21例股骨近端良性骨肿瘤患儿临床资料，21例中男童13例，女童8例；左侧10例，右侧11例；年龄2岁4个月至13岁1个月，平均7.3岁。病理检查结果显示单纯性骨囊肿9例，动脉瘤样骨囊肿5例，非骨化性纤维瘤3例，骨纤维结构不良4例。21例中合并病理性骨折12例。手术策略基于患儿股骨近端肿瘤位置、累及范围、初步诊断及骨骼发育成熟程度，手术方式包括病理活检、病灶刮除、植骨和（或）内固定术。结果 所有病例均获随访，随访时间2.0~4.3年，平均2.8年。完全愈合12例，缺损愈合6例，病变持续存在2例，病灶复发1例。病灶愈合时间4~7个月，平均5.7个月，愈合率85.7%。术前MTST评分3~7分，平均4分；术后MTST评分7~30分，平均27分，与术前比较，差异有统计学意义（t=17.091，P<0.001）。病理性骨折愈合时间6~8周，平均7.2周。术后1例出现髋内翻畸形，1例出现伤口感染，无一例发生骺板损伤、股骨头缺血性坏死或内固定失败。结论 儿童股骨近端良性骨肿瘤的治疗应综合考虑肿瘤位置、累及范围、初步诊断及骨骼发育成熟程度，制定个性化的治疗方案，才能获得满意的功能和影像学结果。
- Abstract:
- Objective To explore the surgical treatment strategies for benign bone lesions of proximal femur in children.Methods Twenty-one children with proximal femoral benign bone lesions were analyzed retrospectively from January 2010 to December 2016.There were 13 boys and 8 girls with a mean age of 7.3 years.The involved side was left (n=10) and right (n=11).Histopathological diagnoses were simple (n=9) or aneurysmal (n=5) bone cysts,nonossifying fibromas (n=3) and fiber dysplasia (n=4).Pathological fracture was concurrent in 12 cases.Surgical strategies were based on patient’s skeletal maturity,localization and initial diagnosis of lesion and amount of bone loss in femoral neck and lateral proximal femur.Surgical procedures consisted of biopsy,curettage,bone grafting and internal fixation when required.Results The average follow-up period was 2.8 (2.0-4.3) years.There were complete healing (n=12),defect healing (n=6),persistent existence (n=2) and recurrence (n=1).The average healing time was 5.7 (4-7) months with a healing rate of 85.7%.Postoperative MTST score showed a statistically significant difference compared with preoperative (t=17.091,P<0.001).The average healing time of pathological fracture was 7.2 (6-8) weeks.There were hip varus deformity (n=1) and wound infection (n=1).Failure of metallic implant,injury to growth plate or avascular necrosis of femoral head were not observed.Conclusion Surgical treatment of benign lesions of proximal femur is based upon localization and initial diagnosis of lesion,amount of bone loss in femoral neck and lateral proximal femur and patient’s skeletal maturity.Effective treatment options for different types of lesions enable local tumor control and yield excellent long-term functional and radiological outcomes.
参考文献/References:
1 宋得夫,毕波,邵景范,等.OPG及RANKL在小儿单纯性骨囊肿与动脉瘤样骨囊肿中的表达研究[J].临床小儿外科杂志,2015,14(3):194-197.DOI:10.3969/j.issn.1671-6353.2015.03.009. Song DG,Bi B,Shao JF,et al.The expression of osteoprotegerin (OPG) and receptor activator nuclear factor κ-B ligand (RANKL) in pediatric bone tumor-like lesions (simple bone cysts and aneurysmal bone cysts)[J].J Clin Ped Sur,2015,14(3):194-197.DOI:10.3969/j.issn.1671-6353.2015.03.009.
2 Canavese F,Samba A,Rousset M.Pathological fractures in children:Diagnosis and treatment options[J].Orthop Traumatol Surg Res,2016,102(1):149-159.DOI:10.1016/j.otsr.2015.05.010.
3 Roposch A,Saraph V,Linhart WE.Treatment of femoral neck and trochanteric simple bone cysts[J].Arch Orthop Trauma Surg,2004,124(7):437-442.DOI:10.1007/s00402-004-0702-5.
4 Jamshidi K,Mirkazemi M,Izanloo AA.Locking plate and fibular strut-graft augmentation in the Reconstruction of unicameral bone cyst of proximal femur in the paediatric population[J].Int Orthop,2018,42(1):169-174.DOI:10.1007/s00264-017-3648-2.
5 Miyamoto W,Takao M,Yasui Y,et al.Endoscopic surgery for symptomatic unicameral bone cyst of the proximal femur[J].Arthrosc Tech,2013,2(4):467-471.DOI:10.1016/j.eats.2013.07.001.
6 Weiss RJ,Ekstrom W,Hansen BH,et al.Pathological subtrochanteric fractures in 194 patients:A comparison of outcome after surgical treatment of pathological and non-pathological fractures[J].J Surg Oncol,2013,107(5):498-504.DOI:10.1002/jso.23277.
7 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].Arch Orthop Trauma Surg,2016,136(8):1051-1061.DOI:10.1007/s00402-016-2486-9.
8 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,1993,1993(286):241-246.DOI:10.1007/978-1-4471-5451-8_128.
9 Chang CH,Stanton RP,Glutting J,et al.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.
10 Fritzsche H,Schaser KD,Hofbauer C.Benign tumours and tumour-like lesions of the bone.General treatment principles[J].Orthopade,2017,46(6):484-497.DOI:10.1007/s00132-017-3429-z.
11 Larousserie F,Kreshak J,Gambarotti M,et al.The importance of radiographic imaging in the microscopic assessment of bone tumors[J].Eur J Radiol,2013,82(12):2100-2114.DOI:10.1016/j.ejrad.2011.11.037.
12 Carvallo PI,Griffin AM,Ferguson PC.Salvage of the proximal femur following pathological fractures involving benign bone tumors[J].J Surg Oncol,2015,112(8):846-852.DOI:10.1002/jso.24072.
13 Wijsbek AE,Vazquez-Garcia BL,Grimer RJ,et al.Giant cell tumour of the proximal femur:Is joint-sparing management ever successful[J].Bone Joint J,2014,96B(1):127-131.DOI:10.1302/0301-620X.96B1.31763.
14 Kundu ZS,Gupta V,Sangwan SS,et al.Curettage of benign bone tumors and tumor like lesions:A retrospective analysis[J].Indian J Orthop,2013,47(3):295-301.DOI:10.4103/0019-5413.111507.
15 Peeters SP,Van Der Geest IC,De Rooy JW,et al.Aneurysmal bone cyst:the role of cryosurgery as local adjuvant treatment[J].J Surg Oncol,2009,100(8):719-724.DOI:10.1002/jso.21410.
16 Dürr H,Maier M,Jansson V,et al.Phenol as an adjuvant for local control in the treatment of giant cell tumour of the bone[J].Eur J Surg Oncol,1999,25(6):610-618.DOI:10.1053/ejso.1999.0716.
17 Malek F,Krueger P,Hatmi ZN,et al.Local control of long bone giant cell tumour using curettage,burring and bone grafting without adjuvant therapy[J].Int Orthop,2006,30(6):495-498.DOI:10.1007/s00264-006-0146-3.
18 Wang EH,Marfori ML,Serrano MV,et al.Is curettage and high-speed burring sufficient treatment for aneurysmal bone cysts?[J].Clin Orthop Relat Res,2014,472(11):3483-3488.DOI:10.1007/s11999-014-3809-1.
19 栗向东,王臻,郭征.儿童股骨近端良性骨肿瘤病理骨折的手术治疗[J].中国骨肿瘤骨病,2011,10(6):558-562,585.DOI:10.3969/j.issn.1671-1971.2011.06.006. Li XD,Wang Z,Guo Z.Surgical treatment for children pathological fractures secondary to benign bone tumor of proximal femur[J].Chin J Bone Tumor & Bone Disease,2011,10(6):558-562,585.DOI:10.3969/j.issn.1671-1971.2011.06.006.
20 Yanagawa T,Watanabe H,Shinozaki TA.Curettage of benign bone tumors without grafts gives sufficient bone strength[J].Acta Orthop,2009,80(1):9-13.DOI:10.1080/17453670902804604.
21 Wang X,Wu X,Xing H,et al.Porous nanohydroxyapatite/collagen scaffolds loading insulin PLGA particles for restoration of critical size bone defect[J].ACS Appl Mater Interfaces,2017,9(13):11380-11391.DOI:10.1021/acsami.6b13566.
22 Roudbari S,Haji Aliloo Sami S,Roudbari M.The clinical results of benign bone tumor treatment with allograft or autograft[J].Arch Iran Med,2015,18(2):109-13.DOI:015182/AIM.009.
23 Hirata M,Murata H,Takeshita H.Use of purified beta-tricalcium phosphate for filling defects after curettage of benign bone tumours[J].Int Orthop,2006,30(6):510-513.DOI:10.1007/s00264-006-0156-1.
24 Dormans JP,Pill SG.Fractures through bone cysts:unicameral bone cysts,aneurysmal bone cysts,fibrous cortical defects,and nonossifying fibromas[J].Instr Course Lect,2002,51:457-467.
25 Erol B,Pill SG,Guttenberg ME,et al.Pathologic hip fracture in a 4-year-old boy[J].Clin Orthop Relat Res,2002(403):264-273.DOI:10.1097/00003086-200210000-00038.
备注/Memo
收稿日期:2019-05-30。
基金项目:浙江省科技厅计划项目（编号：2017C33026）
通讯作者:叶文松,Email:6192005@zju.edu.cn