股骨颈骨囊肿合并病理骨折的手术治疗及随访结果

目的分析股骨颈骨囊肿合并病理骨折的手术治疗方法及随访结果。方法自1980年6月至2004年12月有7名患者在我科接受治疗并有完整随访，其中男性4例，女性3例。年龄：13岁到56岁，平均27．8岁。所有病例均按Garden分型后，分别行病灶刮除，自体髂骨、异体骨、髂骨加骨水泥、单纯骨水泥及自体骨加异体骨填充，固定方式有鹅头钉、空心钉及DHS钉内固定。1例仅行病灶刮除，异体骨植骨，未作内固定。结果7例均获得较满意的随访。随访时间为18个月至144个月，平均75个月。有4例于术后12个月至48个月出现股骨头坏死，表现为髋关节疼痛，活动受限，跛行；X线表现为股骨头塌陷，变形，关节间隙变窄。结论股骨颈骨囊肿合并病理骨折，治疗难度大，术中骨折复位及维持位置困难，术后易出现股骨头缺血坏死，特别是采用骨水泥填充加内固定方法治疗更易发生．术中应尽可能减少对股骨头血运的干扰及破坏，避免过早负重。

Surgical treatment of solitary bone cyst of femoral neck with pathological fracture

Objective To analyze the outcome of patients with solitary bone cyst of femoral neck with pathologic fracture after surgical treatment. Methods 7 patients underwent treatment and followed up in our hospital from 1980 to 2004, they were 4 males and 3 females. The age is between 13 and 56 and the average age is 27.8 . All these fractures were graded according to Garden system and treated respectively by curetting the lesion, filling the spaces with autograft and/or allograft. Internal fixations were eannulated screw or DHS . Results All these cases have satisfying follow up. The follow up time is 18 to 144 months, 75 months on average. Four cases had necrosis of femoral head, manifested as pain of the articulation of hip, limitation of motion and lameness. The heads collapsed and deformed and articular gaps were narrower in X ray plate films. Conclusions It is difficult to treat for the bone cyst in the neck of the femur with pathologic fracture, reduction in operation was difficult to sustain and the necrosis of femoral head was often seen after operation , especially when filled with bone cement and fixed with internal fixation. So we should avoid the interference and destruction of the blood vessels and avoid early weight bearing.