股骨近端良性骨肿瘤和瘤样病变的手术治疗

股骨近端的良性骨肿瘤和瘤样病变并不少见，其病变亦多种多样，术前术后均易发生各种并发症。本文统计分析了我所１９８３年７月～１９９３年１０月收治的４９例股骨近端良性骨肿瘤和瘤样病变的病人，所有病人均经手术治疗，术后病理诊断。本组病人采用病变刮除，５０％氯化锌烧灼，皮质骨和／或松质骨植骨的方法治疗。不同的植骨方法对病变的预后有不同的影响，皮质骨植骨有助于防止术后髋内翻和病理骨折的发生。对于病变累及股骨头的病人，其病变较大可能发生股骨头无菌坏死，用单纯病变刮除，５０％氯化锌烧灼加植骨的方法难以奏效，需用更彻底的方法去除病变和功能重建，如人工股骨头置换。     

骨与关节肿瘤及瘤样病变4327例统计分析

我院自１９５８～１９９４年４月经病理证实的骨与关节肿瘤及瘤样病变共计４３２７例，其中原发良性骨肿瘤１５４５例（３５．７０％），骨巨细胞瘤５００例（１１．５６％），恶性骨肿瘤１０４６例（２４．１７％），转移瘤３８１例（８．８０％），瘤样病变４６１例（１０．６５％），关节滑膜瘤及瘤样病变３９４例（９．１０％）。良性骨肿瘤以骨软骨瘤发病率最高，计５９５例（３８．５１％），软骨瘤次之（２３．８８％）；恶性骨肿瘤以骨肉瘤最多３４８例（３３．２７％），软骨肉瘤次之（２５．１４％）；瘤样病变以纤维异样增殖症最多１９３例（４１．８７％），骨囊肿次之（２８．２０％）。良、恶性骨肿瘤均以１１～３０岁多见，分别为５６．１１％及５７．０３％。其好发部位均以股骨和胫骨最多见，分别为３７．１５％及４３．６６％。     

儿童股骨近端骨肿瘤的手术治疗

目的：总结儿童股骨近端骨肿瘤手术治疗的经验教训。方法：37例14岁以下的患者接受不同方式的手术治疗，平均随访37．2个月。结果：病变刮除、瘤壁残留肿瘤组织灭活、植骨术仍是目前治疗良性病变常用的手术方法，应避免损伤股骨头骨骺。对病灶范围较大伴有髋内翻畸形的良性病变，行病变部分刮除、外翻截骨及内固定后可维持正常的颈干角和髋关节功能。瘤段切除、长柄人工股骨头置换术，是修复股骨近端恶性骨肿瘤切除后大块骨缺损的一种较好的方法，具有早期恢复肢体功能、并发症少、材料来源充足等优势。结论：儿童股骨近端骨肿瘤的手术治疗应考虑到病变的性质、侵袭范围、股骨近端的应力分布及儿童骨骺未闭合等特点，采用适当的术式，多可获得良好的效果。     

儿童股骨近端肿瘤合并病理骨折的手术治疗

目的：总结儿童股骨近端病理骨折手术治疗的经验教训。方法：22例14岁以下的患者接受不同方式的手术治疗。平均随访35.4个月。结果：病变刮除、瘤壁残留肿瘤组织灭活,植骨术仍是目前治疗良性病变常用的手术方法,应避免损伤股骨头骨骺。多病灶型骨纤维结构不良经外翻截骨及内固定后可维持正常的颈干角和髋关节功能。肿瘤复发,植骨吸收是常见的并发症,结论：儿童股骨近端肿瘤合并病理骨折的手术治疗应考虑到病变的性质、侵袭范围、股骨近端的应力分布及儿童骨骺未闭合等特点。     

手部骨肿瘤及瘤样病变

作者对１９０例手部骨肿瘤及瘤样病变从临床，Ｘ线及病理上进行了回顾性分析．其中良性肿瘤明显多于恶性肿瘤，其比例为２５．４：１．以软骨瘤最多见（７６．３％），骨软骨瘤次之（１１．６％）．恶性肿瘤少见，以转移瘤和软骨肉瘤较多见．各种肿瘤的分布部位似有特点，软骨性肿瘤以近节指骨多见，掌骨次之．骨巨细胞瘤以掌骨多见．转移瘤以末节指骨多见．病理诊断是最可靠的方法，但在确诊时必须结合临床及Ｘ线表现．     

冷冻灭活皮质骨移植治疗股骨头颈部侵袭性肿瘤的疗效观察

目的 评估病灶刮除液氮冷冻灭活结合皮质骨支撑治疗股骨头颈部侵袭性骨肿瘤的疗效。方法 １１例患者在诊断明确后均采取病灶刮除加液氮注入法冷冻灭活,缺损处以自体（或异体）腓骨和自体髂骨填充修复,７例辅以内固定。结果 １１例随访３～１０年（平均６年６个月）。参照Ｅｎｎｅｋ－ｉｎｇ评定标准进行功能评估,优７例,良４例。结论 该疗法是治疗股骨头颈部侵袭性肿瘤的良好方法之一。     

介入和髓芯减压植骨治疗股骨头缺血性坏死

目的探讨介入和髓芯减压、坏死区域掏空植骨治疗股骨头缺血性坏死的疗效。方法对57例患者采用介入和髓芯减压、坏死区域掏空植骨。结果57例经1~4·5年(平均2·9年)随访,效果满意。结论该方法损伤小,操作简便,是治疗股骨头缺血性坏死的有效方法。     

Treatment of femoral neck and trochanteric simple bone cysts

Introduction Problems associated with common treatment modalities of bone cysts located in the proximal femur include a high blood loss, infection, lack of stability, donor-site morbidity, restriction to normal activity, and high recurrence rate.Materials and methods Twelve patients with a simple bone cyst of the proximal femur were treated with retrograde flexible nailing. Six showed a pathological fracture. Mean age at surgery was 10.4 years, mean follow-up was 57 months. Radiographs were classified as healed, healed with residuals, recurred, or no response.Results The mean healing period was 38.8 months. Two cysts healed completely, nine healed with residuals. There was no recurrence or non-responder. In a fractured cyst a perforation of a nail through the cyst occurred 4 months after nailing.Conclusion The method is less invasive and offers early stability to the bone without the need for cast immobilization.None of the authors received financial support for this study.This study was conducted at the Department of Paediatric Orthopaedic Surgery, Medical University, Graz, Austria.A. Roposch is the recipient of the Research Training Competition Award, Population Health Sciences Program, Hospital for Sick Children, Toronto, Canada.     

Classifying femoral bone deficiency: Picking the right tool for the job

The number of total hip arthroplasties continues to increase each year, and with it grows the demand for surgeons prepared to manage complicated revisions. To date, the Paprosky classification system is the most commonly used, well described, and successfully implemented classification system for periprosthetic femoral bone loss. In this review, the Paprosky femoral bone loss classification is presented in detail, using illustrative examples of cases encountered by the contributing authors.     

Lytic lesions in the femoral neck: Importance of location and evaluation of a novel minimally invasive repair technique

Proximal femoral metastases can lead to pathologic fracture. The goals of this study were to improve guidelines for assessing pathologic hip fracture risk by quantifying the effect of location of femoral neck metastases on hip strength under single‐limb stance loading and to evaluate the effectiveness of a proposed minimally invasive surgical repair technique for restoring hip strength. Twelve matched pairs of human cadaveric proximal femora were used to create a total of 564 finite element models before and after introduction and repair of simulated lytic defects, modeled as spherical voids, at various locations within the femoral neck. Defect site greatly affected hip strength (p < 0.001). Defects in the inferomedial aspect of the neck and in the dense trabecular bone near the base of the femoral head had the greatest effect, with hip strengths 23% to 72% and 43% to 64% that of the intact strength, respectively, for 20‐mm diameter defects. Even so, the proposed percutaneous repair technique restored static strength of femora with defects at all of the studied locations. These findings may lead to a reduction in the number of patients who suffer a preventable pathologic fracture, a decreased likelihood of unnecessary surgery, and a less invasive prophylactic surgical procedure. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:1127–1132, 2008     

Trabecular bone changes in the greater trochanter after fracture of the femoral neck

Bone samples were taken from the trabecular part of the greater trochanter in 32 patients who had had a fracture of the ipsilateral femoral neck, and from 24 patients who had coxarthrosis. 42 cadavers served as controls. The samples were sectioned, stained and examined histologically.

The coxarthrosis cases differed only slightly from normal, whereas the fracture cases had increased osteoid volume and surface. Osteoclasts were also increased in number, as were active osteoblasts.     

股骨远端骨折的手术治疗

目的探讨股骨远端骨折的手术治疗方法及合并症的预防。方法对1991年～2001年,348例股骨远端骨折手术治疗,选用螺钉、动力加压钢板(DCP)、角钢板、动力髁部螺钉(DCS)、股骨髁钢板、带锁髓内钉治疗股骨远端骨折。研究内固定物的使用、骨折复位、植骨、骨折不愈合等相关问题。结果13例发生内固定失效、钢板断裂,需要重新固定植骨。8例延迟愈合,二期植骨。其余骨折均愈合。14例术后伤口感染,18例晚期出现肢体短缩,范围1～4cm。52例因骨折愈合后膝关节屈曲小于90°需要行松解手术。结论手术治疗股骨远端骨折能够恢复解剖结构,从而最大限度地恢复肢体的功能。     

介入+异体腓骨移植治疗成人股骨头缺血性坏死

目的 探讨介入 异体腓骨移植冶疗成人股骨头缺血性坏死近期疗效。方法 12例18髋，结合影像学分期：Ficat Ⅰ期11髋，Ⅱ期6髋，Ⅲ期1髋，分别先进行介入治疗，2周后行病灶清除 异体腓骨移植手术。结果 按成人股骨头坏死疗效的百分评价方法，对12例18髋随防12～48个月，平均随防29个月，优9髋，良8髋，差1髋，优良率94．4％。结论 介入 异体腓骨移植不但改善股骨头血运，同时彻底清除死骨，减压植骨增加股骨头负重区软骨下骨的机械支撑，有利于股骨头坏死的重建修复，适用于Ficat Ⅰ、Ⅱ期患者。     

姑息性手术治疗系统性红斑狼疮并发股骨头缺血性坏死

目的评价姑息性手术治疗系统性红斑狼疮（SLE）并发股骨头缺血性坏死（ANFH）的疗效。方法采用姑息性手术治疗SLE并发ANFH患者6例11髋（另外1髋行了全髋置换术）,选取同期6例ANFH分期大致相近的激素性（非SLE）患者作为对照。结果治疗组11髋总有效为9髋,其中优良为6髋;另外2髋疼痛有所减轻,但X线显示坏死区扩大,所植骨逐渐被吸收。对照组12髋总有效12髋,其中优良为8髋。结论从近期疗效来看,姑息性手术治疗SLE并发ANFH疗效基本满意。     

Evaluation of osteosynthesis with dual fibular bone grafting for neglected femoral neck fractures

BackgroundFemoral neck fractures in young adults is an unsolved problem and neglected femoral neck fractures presents more challenge to the orthopaedics surgeon if femoral head salvage is attempted. We reviewed the operative results of neglected femoral neck fractures in young adults with fixation with dual fibular bone grafting Purpose of study was evaluation of epidemiological, clinical, functional, rehabilitative outcome and complications in such patients.MethodsTwentyeight patients in age group 18–50 years were operated having fracture neck femur by dual fibular bone grafting in the Department of Orthopaedics, S.N. Medical College, Agra in (May 2005–February 2008) and divided into two groups. Group A: comprised of 8 patients treated by dual fibular bone grafting alone and Group B: comprised of 18 patients treated by dual fibular bone grafting with single cancellous hip screw.ResultsAll the patients of the present series were having neglected intracapsular fracture, neck femur which were treated by dual fibular bone grafting with or without cancellous hip screw fixation. Majority of the patients had good to fair result according to Larson method with average time of union 16 weeks. All patients had useful range of movement at hip. Satisfactory union was achieved in all patients except two.ConclusionDouble bone grafting is a simple and cost effective modality of treatment for late femoral neck fracture with good results. It is a stable and biological method of fixation with preservation of natural femoral head with fewer complications.