Assessment of interobserver variation in Garden classification and management of fresh intracapsular femoral neck fracture in adults

Objective： To assess the interobserver agreement on Garden classification of fresh femoral neck fracture and management plan based on anteroposterior （AP） view and also assess if the addition of lateral view changes the classification and management plan. Methods： Ten orthopaedic surgeons were asked to classify 35 femoral neck fractures on AP view only and propose the management plan. Then the same films were reshown in conjunction with their lateral view after 10 days. Results were compared with respect to the classification and management plan between two groups. Interobserver agreement was calculated using Fleiss＇ kappa. Results： There was only a fair interobserver agreement （kappa value 0.39） on Garden classification on AP view only which improved to moderate agreement （kappa value 0.52） after adding a lateral view. While there was only a slight improvement in the interobserver agreement on the management plan on AP view only （kappa value 0.50） and AP combined with lateral views （kappa value 0.52）. Supplementation of the lateral view changed the classification in 15.42% of the cases and altered the management plan in 23.14% of the cases. Conclusion： We conclude that lateral view should be obtained routinely on all patients with suspected femoral neck fracture as it definitely has a role in planning treatment of femoral neck fracture.     

提高股骨干骨折合并同侧股骨颈骨折早期诊断率的前瞻性研究

Objective To evaluate a serf-designed diagnostic protoeol which can early detect a femoral neck fracture for patients with a femoral shaft fracture. Methods From September 2005 to June 2007, a self-developed protocol was used to detect an ipsilateral femoral neck fracture for all the patients with femoral shaft fracture who had sought treatment in our department. This protocol consisted of anteroposterior plain radiography of internal rotator, intraoperative fluoroscopy of the hip, a fine (2 mm) cut computed to-mographic scan through the femoral neck, postoperative anteroposterior and lateral plain radiography of the hip in the operating room prior to awakening the patient, at the time of follow-up anteroposterior and lateral plain radiography of the hip in the presence of hip pain. The diagnostic effects of the protocol were compared with those of conventional diagnosis used for all the patients with femoral shaft fracture who had sought treatment in our department from September 2003 to August 2005. A chi-square analysis comparing the protocol group (September 2005 to June 2007) and the non-protocol group (September 2003 to August 2005) was used to assess the early and delayed diagnosis rates for an associated ipsilateral femoral neck fracture. Results The earlydiagnosis rate of an associated femoral neck fracture by the protocol was 93.8%, markedly higher than that by conventional method (46.2%), with statistically significant difference (χ2 = 4.069, P =0.044). Conclu-sion In presence of a femoral shaft fracture. this protocol consisting of plain radiography of intemal rotator, intraoperative fluoroscopy of the hip, fine cut computed tomographic scan of the femoral neck, postoperative plain radiography of the hip, and follow-up plain radiography of the hip in the presence of hip pain, may sig-nificantly improve the diagnostic rate of an associated femoral neck fracture.     

提高股骨干骨折合并同侧股骨颈骨折早期诊断率的前瞻性研究

Objective To evaluate a serf-designed diagnostic protoeol which can early detect a femoral neck fracture for patients with a femoral shaft fracture. Methods From September 2005 to June 2007, a self-developed protocol was used to detect an ipsilateral femoral neck fracture for all the patients with femoral shaft fracture who had sought treatment in our department. This protocol consisted of anteroposterior plain radiography of internal rotator, intraoperative fluoroscopy of the hip, a fine (2 mm) cut computed to-mographic scan through the femoral neck, postoperative anteroposterior and lateral plain radiography of the hip in the operating room prior to awakening the patient, at the time of follow-up anteroposterior and lateral plain radiography of the hip in the presence of hip pain. The diagnostic effects of the protocol were compared with those of conventional diagnosis used for all the patients with femoral shaft fracture who had sought treatment in our department from September 2003 to August 2005. A chi-square analysis comparing the protocol group (September 2005 to June 2007) and the non-protocol group (September 2003 to August 2005) was used to assess the early and delayed diagnosis rates for an associated ipsilateral femoral neck fracture. Results The earlydiagnosis rate of an associated femoral neck fracture by the protocol was 93.8%, markedly higher than that by conventional method (46.2%), with statistically significant difference (χ2 = 4.069, P =0.044). Conclu-sion In presence of a femoral shaft fracture. this protocol consisting of plain radiography of intemal rotator, intraoperative fluoroscopy of the hip, fine cut computed tomographic scan of the femoral neck, postoperative plain radiography of the hip, and follow-up plain radiography of the hip in the presence of hip pain, may sig-nificantly improve the diagnostic rate of an associated femoral neck fracture.     

提高股骨干骨折合并同侧股骨颈骨折早期诊断率的前瞻性研究

Objective To evaluate a serf-designed diagnostic protoeol which can early detect a femoral neck fracture for patients with a femoral shaft fracture. Methods From September 2005 to June 2007, a self-developed protocol was used to detect an ipsilateral femoral neck fracture for all the patients with femoral shaft fracture who had sought treatment in our department. This protocol consisted of anteroposterior plain radiography of internal rotator, intraoperative fluoroscopy of the hip, a fine (2 mm) cut computed to-mographic scan through the femoral neck, postoperative anteroposterior and lateral plain radiography of the hip in the operating room prior to awakening the patient, at the time of follow-up anteroposterior and lateral plain radiography of the hip in the presence of hip pain. The diagnostic effects of the protocol were compared with those of conventional diagnosis used for all the patients with femoral shaft fracture who had sought treatment in our department from September 2003 to August 2005. A chi-square analysis comparing the protocol group (September 2005 to June 2007) and the non-protocol group (September 2003 to August 2005) was used to assess the early and delayed diagnosis rates for an associated ipsilateral femoral neck fracture. Results The earlydiagnosis rate of an associated femoral neck fracture by the protocol was 93.8%, markedly higher than that by conventional method (46.2%), with statistically significant difference (χ2 = 4.069, P =0.044). Conclu-sion In presence of a femoral shaft fracture. this protocol consisting of plain radiography of intemal rotator, intraoperative fluoroscopy of the hip, fine cut computed tomographic scan of the femoral neck, postoperative plain radiography of the hip, and follow-up plain radiography of the hip in the presence of hip pain, may sig-nificantly improve the diagnostic rate of an associated femoral neck fracture.     

提高股骨干骨折合并同侧股骨颈骨折早期诊断率的前瞻性研究

Objective To evaluate a serf-designed diagnostic protoeol which can early detect a femoral neck fracture for patients with a femoral shaft fracture. Methods From September 2005 to June 2007, a self-developed protocol was used to detect an ipsilateral femoral neck fracture for all the patients with femoral shaft fracture who had sought treatment in our department. This protocol consisted of anteroposterior plain radiography of internal rotator, intraoperative fluoroscopy of the hip, a fine (2 mm) cut computed to-mographic scan through the femoral neck, postoperative anteroposterior and lateral plain radiography of the hip in the operating room prior to awakening the patient, at the time of follow-up anteroposterior and lateral plain radiography of the hip in the presence of hip pain. The diagnostic effects of the protocol were compared with those of conventional diagnosis used for all the patients with femoral shaft fracture who had sought treatment in our department from September 2003 to August 2005. A chi-square analysis comparing the protocol group (September 2005 to June 2007) and the non-protocol group (September 2003 to August 2005) was used to assess the early and delayed diagnosis rates for an associated ipsilateral femoral neck fracture. Results The earlydiagnosis rate of an associated femoral neck fracture by the protocol was 93.8%, markedly higher than that by conventional method (46.2%), with statistically significant difference (χ2 = 4.069, P =0.044). Conclu-sion In presence of a femoral shaft fracture. this protocol consisting of plain radiography of intemal rotator, intraoperative fluoroscopy of the hip, fine cut computed tomographic scan of the femoral neck, postoperative plain radiography of the hip, and follow-up plain radiography of the hip in the presence of hip pain, may sig-nificantly improve the diagnostic rate of an associated femoral neck fracture.     

提高股骨干骨折合并同侧股骨颈骨折早期诊断率的前瞻性研究

Objective To evaluate a serf-designed diagnostic protoeol which can early detect a femoral neck fracture for patients with a femoral shaft fracture. Methods From September 2005 to June 2007, a self-developed protocol was used to detect an ipsilateral femoral neck fracture for all the patients with femoral shaft fracture who had sought treatment in our department. This protocol consisted of anteroposterior plain radiography of internal rotator, intraoperative fluoroscopy of the hip, a fine (2 mm) cut computed to-mographic scan through the femoral neck, postoperative anteroposterior and lateral plain radiography of the hip in the operating room prior to awakening the patient, at the time of follow-up anteroposterior and lateral plain radiography of the hip in the presence of hip pain. The diagnostic effects of the protocol were compared with those of conventional diagnosis used for all the patients with femoral shaft fracture who had sought treatment in our department from September 2003 to August 2005. A chi-square analysis comparing the protocol group (September 2005 to June 2007) and the non-protocol group (September 2003 to August 2005) was used to assess the early and delayed diagnosis rates for an associated ipsilateral femoral neck fracture. Results The earlydiagnosis rate of an associated femoral neck fracture by the protocol was 93.8%, markedly higher than that by conventional method (46.2%), with statistically significant difference (χ2 = 4.069, P =0.044). Conclu-sion In presence of a femoral shaft fracture. this protocol consisting of plain radiography of intemal rotator, intraoperative fluoroscopy of the hip, fine cut computed tomographic scan of the femoral neck, postoperative plain radiography of the hip, and follow-up plain radiography of the hip in the presence of hip pain, may sig-nificantly improve the diagnostic rate of an associated femoral neck fracture.     

提高股骨干骨折合并同侧股骨颈骨折早期诊断率的前瞻性研究

Objective To evaluate a serf-designed diagnostic protoeol which can early detect a femoral neck fracture for patients with a femoral shaft fracture. Methods From September 2005 to June 2007, a self-developed protocol was used to detect an ipsilateral femoral neck fracture for all the patients with femoral shaft fracture who had sought treatment in our department. This protocol consisted of anteroposterior plain radiography of internal rotator, intraoperative fluoroscopy of the hip, a fine (2 mm) cut computed to-mographic scan through the femoral neck, postoperative anteroposterior and lateral plain radiography of the hip in the operating room prior to awakening the patient, at the time of follow-up anteroposterior and lateral plain radiography of the hip in the presence of hip pain. The diagnostic effects of the protocol were compared with those of conventional diagnosis used for all the patients with femoral shaft fracture who had sought treatment in our department from September 2003 to August 2005. A chi-square analysis comparing the protocol group (September 2005 to June 2007) and the non-protocol group (September 2003 to August 2005) was used to assess the early and delayed diagnosis rates for an associated ipsilateral femoral neck fracture. Results The earlydiagnosis rate of an associated femoral neck fracture by the protocol was 93.8%, markedly higher than that by conventional method (46.2%), with statistically significant difference (χ2 = 4.069, P =0.044). Conclu-sion In presence of a femoral shaft fracture. this protocol consisting of plain radiography of intemal rotator, intraoperative fluoroscopy of the hip, fine cut computed tomographic scan of the femoral neck, postoperative plain radiography of the hip, and follow-up plain radiography of the hip in the presence of hip pain, may sig-nificantly improve the diagnostic rate of an associated femoral neck fracture.     

提高股骨干骨折合并同侧股骨颈骨折早期诊断率的前瞻性研究

Objective To evaluate a serf-designed diagnostic protoeol which can early detect a femoral neck fracture for patients with a femoral shaft fracture. Methods From September 2005 to June 2007, a self-developed protocol was used to detect an ipsilateral femoral neck fracture for all the patients with femoral shaft fracture who had sought treatment in our department. This protocol consisted of anteroposterior plain radiography of internal rotator, intraoperative fluoroscopy of the hip, a fine (2 mm) cut computed to-mographic scan through the femoral neck, postoperative anteroposterior and lateral plain radiography of the hip in the operating room prior to awakening the patient, at the time of follow-up anteroposterior and lateral plain radiography of the hip in the presence of hip pain. The diagnostic effects of the protocol were compared with those of conventional diagnosis used for all the patients with femoral shaft fracture who had sought treatment in our department from September 2003 to August 2005. A chi-square analysis comparing the protocol group (September 2005 to June 2007) and the non-protocol group (September 2003 to August 2005) was used to assess the early and delayed diagnosis rates for an associated ipsilateral femoral neck fracture. Results The earlydiagnosis rate of an associated femoral neck fracture by the protocol was 93.8%, markedly higher than that by conventional method (46.2%), with statistically significant difference (χ2 = 4.069, P =0.044). Conclu-sion In presence of a femoral shaft fracture. this protocol consisting of plain radiography of intemal rotator, intraoperative fluoroscopy of the hip, fine cut computed tomographic scan of the femoral neck, postoperative plain radiography of the hip, and follow-up plain radiography of the hip in the presence of hip pain, may sig-nificantly improve the diagnostic rate of an associated femoral neck fracture.     

提高股骨干骨折合并同侧股骨颈骨折早期诊断率的前瞻性研究

Objective To evaluate a serf-designed diagnostic protoeol which can early detect a femoral neck fracture for patients with a femoral shaft fracture. Methods From September 2005 to June 2007, a self-developed protocol was used to detect an ipsilateral femoral neck fracture for all the patients with femoral shaft fracture who had sought treatment in our department. This protocol consisted of anteroposterior plain radiography of internal rotator, intraoperative fluoroscopy of the hip, a fine (2 mm) cut computed to-mographic scan through the femoral neck, postoperative anteroposterior and lateral plain radiography of the hip in the operating room prior to awakening the patient, at the time of follow-up anteroposterior and lateral plain radiography of the hip in the presence of hip pain. The diagnostic effects of the protocol were compared with those of conventional diagnosis used for all the patients with femoral shaft fracture who had sought treatment in our department from September 2003 to August 2005. A chi-square analysis comparing the protocol group (September 2005 to June 2007) and the non-protocol group (September 2003 to August 2005) was used to assess the early and delayed diagnosis rates for an associated ipsilateral femoral neck fracture. Results The earlydiagnosis rate of an associated femoral neck fracture by the protocol was 93.8%, markedly higher than that by conventional method (46.2%), with statistically significant difference (χ2 = 4.069, P =0.044). Conclu-sion In presence of a femoral shaft fracture. this protocol consisting of plain radiography of intemal rotator, intraoperative fluoroscopy of the hip, fine cut computed tomographic scan of the femoral neck, postoperative plain radiography of the hip, and follow-up plain radiography of the hip in the presence of hip pain, may sig-nificantly improve the diagnostic rate of an associated femoral neck fracture.     

提高股骨干骨折合并同侧股骨颈骨折早期诊断率的前瞻性研究

Objective To evaluate a serf-designed diagnostic protoeol which can early detect a femoral neck fracture for patients with a femoral shaft fracture. Methods From September 2005 to June 2007, a self-developed protocol was used to detect an ipsilateral femoral neck fracture for all the patients with femoral shaft fracture who had sought treatment in our department. This protocol consisted of anteroposterior plain radiography of internal rotator, intraoperative fluoroscopy of the hip, a fine (2 mm) cut computed to-mographic scan through the femoral neck, postoperative anteroposterior and lateral plain radiography of the hip in the operating room prior to awakening the patient, at the time of follow-up anteroposterior and lateral plain radiography of the hip in the presence of hip pain. The diagnostic effects of the protocol were compared with those of conventional diagnosis used for all the patients with femoral shaft fracture who had sought treatment in our department from September 2003 to August 2005. A chi-square analysis comparing the protocol group (September 2005 to June 2007) and the non-protocol group (September 2003 to August 2005) was used to assess the early and delayed diagnosis rates for an associated ipsilateral femoral neck fracture. Results The earlydiagnosis rate of an associated femoral neck fracture by the protocol was 93.8%, markedly higher than that by conventional method (46.2%), with statistically significant difference (χ2 = 4.069, P =0.044). Conclu-sion In presence of a femoral shaft fracture. this protocol consisting of plain radiography of intemal rotator, intraoperative fluoroscopy of the hip, fine cut computed tomographic scan of the femoral neck, postoperative plain radiography of the hip, and follow-up plain radiography of the hip in the presence of hip pain, may sig-nificantly improve the diagnostic rate of an associated femoral neck fracture.     

Combined anterior and lateral approaches for bone tumors of the femoral neck and head

Few reports in the literature describe the treatment experience of benign lesions of the femoral head and neck. Between July 2005 and August 2009, twenty-four patients with bone tumor of the femoral neck and head were treated at the authors' institution. Fourteen patients had pathological fractures of the femoral neck; in the other 10 patients, the bone cortex was involved. Average tumor size was 78 cc (range, 45-130 cc). The patients were treated by curettage plus bone grafting via an anterior approach (Smith-Petersen incision) and internal fixation via a lateral approach (Hardinge approach). Average follow-up was 34 months (range, 10-68 months).Average blood loss and operative time were 450 mL and 87 minutes, respectively. Six patients experienced complications: 2 superficial wound infections, 2 immunological rejections, and 2 hollow screw loosenings and slight limps at 12 and 16 months postoperatively, respectively. No recurrence or other serious complications, such as pathological fracture, ischemic necrosis of the femoral head, or joint degeneration, occurred. Average Musculoskeletal Tumor Society score for lower extremity function was 29.2 (range, 27-30) at final follow-up, and all patients resumed their normal preoperative work and were pain free postoperatively, although 1 patient had a slight limp at final follow-up.A combination of anterior and lateral approaches may produce good clinical and functional results with minimal complications in bone tumors of the femoral neck.     

股骨头颈部肿瘤及瘤样病变的手术治疗

目的探讨股骨头颈部肿瘤及瘤样病变的手术治疗效果.方法对19例股骨头颈部瘤样病变及良性肿瘤患者行病灶刮除＋自体髂骨植骨术.结果 19例均获随访,时间1年3个月～4年,平均2.7年.患者术后6～9个月植骨融合,无股骨头坏死或塌陷,肿瘤无复发征象.结论对股骨头颈部良性肿瘤及瘤样病变采用病灶清除＋植骨可取得良好效果.     

Minimally invasive direct anterior approach versus standard lateral approach in the management of tumors of the femoral neck

BackgroundTo compare the clinical outcomes of patients with benign or aggressive tumors of the femoral neck who underwent surgical curettage with the use of the direct anterior approach (DAA) and a standard lateral approach.MethodsThose patients from 2010 to 2017 were retrospectively enrolled. The patients were divided into two groups: group A, consisting of patients who had undergone surgery via the lateral approach; and group B, consisting of patients who had undergone the same procedure via the DAA.ResultsFifty-eight patients were divided into group A (n = 46) and group B (n = 12). The median follow-up was 43 months (15–97 months). There was no significant difference in the 1-year and 3-year recurrence rates (p = 0.74). Group B had comparable operation time and a significantly shorter incision length, less intraoperative blood loss, less postoperative drainage, a shorter hospital stay and less pain on the first postoperative day. Group B also had better hip function as assessed by the Harris Hip Score one month and one year postoperatively. One patient in group B experienced intraoperative incomplete fracture of the femoral neck, which was treated conservatively.ConclusionsSurgical curettage for patients with benign or aggressive tumors of the femoral neck via the DAA had a comparable local control rate and a better perioperative and functional outcome than via the lateral approach. Certain quality of the femoral neck should be required to avoid pathological fracture, which is difficult to treat by internal fixation in the DAA.     

Chondroblastoma: a rare cause of femoral neck fracture in a teenager

Chondroblastomas usually present in the epiphyseal region of bones in skeletally immature patients. These uncommon, benign tumors are usually treated with curettage and use of a bone-void filler. Here we report a case of a hip fracture secondary to an underlying chondroblastoma in a 19-year-old woman. Open biopsy with intraoperative frozen section pointed toward a diagnosis of chondroblastoma. Extended curettage was performed, followed by cryotherapy with a liquid nitrogen gun and filling of the defect with calcium phosphate bone substitute. The femoral neck fracture was stabilized with a sliding hip screw construct. The patient progressed well and continued to regain functional status. A final pathology report confirmed the lesion to be a chondroblastoma. Clinicians should have heightened awareness of a pathologic lesion in a young person presenting with a femoral neck fracture and should consider the uncommon differential diagnosis that the lesion is located in the greater trochanter apophysis.     

19例股骨颈原发溶骨性损害的手术治疗

目的：总结股骨颈原发溶骨性损害的手术治疗结果。方法：自1973－1999年共收治股骨颈原发溶骨性病损19例,其中瘤样样病变11例,良性肿瘤4例,恶性骨肿瘤2例,骨梗死2例,采用瘤段切除,人工股骨头置换1例,肿瘤刮除,骨水泥和髓内钉填塞,接骨板固定2例,肿瘤刮除植骨16例。结果：随访6个月－20年,平均5．8年,骨肉瘤患者术后2年死于肿瘤肺转移,软骨肉瘤患者术后1．5年肿瘤局部复发,行股骨近端置换,1例骨水泥和三翼钉植入者8年后患侧股骨粗隆部骨折,再次手术安装接骨板,3个月后骨折愈合,余患者4－8个月植骨融合,无股骨头坏死或塌陷,肿瘤无复发征象,结论：原发股骨颈溶骨性损害以瘤样病变居多,良性病变无论病变范围的大小,采用病灶清除,腔内植骨骨或骨水泥填塞均取得良好效果。     

颗粒打压植骨辅钢板内固定治疗股骨近端骨肿瘤或瘤样病损

目的 :评价颗粒打压植骨辅钢板内固定治疗股骨近端骨肿瘤或瘤样病损的临床可行性。方法 :2013年1月至2016年1月治疗股骨近端骨肿瘤或瘤样病损26例,均未发生病理性骨折,男12例,女14例;年龄8~62岁,平均34.2岁。病理结果:纤维结构不良11例,骨孤立性骨囊肿7例,骨巨细胞瘤3例,动脉瘤样骨囊肿3例,非骨化性纤维瘤1例,良性纤维组织细胞瘤1例。术前未进行病灶活组织检查,术后送慢病理,手术采取颗粒打压植骨辅钢板内固定。结果:26例均随访至恢复日常生活,随访时间8~42个月,平均25个月。参照骨与软组织肿瘤协会(MSTS)进行功能评估。术后末次复查股骨正侧位X线片,植骨边缘及植骨体部未见低密度影,植骨区骨愈合良好,所有患者未见复发及转移病灶,内固定物无松动、变形。髋关节功能恢复良好,所有患者无再骨折和畸形进展。结论:股骨近端肿瘤复发与病灶刮除植骨技术有关,刮除后采用化学、物理方法处理消灭残留的肿瘤细胞,利用此方法可以获得疾病的长期治愈,减少复发,恢复髋关节功能。     

异体骨联合自体骨髓移植治疗骨囊肿

目的介绍异体骨联合自体骨髓移植治疗骨囊肿的手术方法。方法2004年2月～2006年3月,共收治骨囊肿13例,男6例,女7例;年龄5～16岁,平均11.5岁。其中肱骨近端5例,股骨颈2例,股骨干3例,胫骨上段2例,胫骨下段1例;合并病理性骨折5例。所有患者均行瘤体刮除、异体骨与自体骨髓联合移植术,8例加行器械固定术。结果术后5例切口期愈合;8例切口引流物150ml以上,其中5例切口渗液,3例伤口延期愈合。全部获随访6个月～2年,根据Capanne标准,术后X线片达级愈合10例,级3例,时间为3.5～8个月,平均5.2个月,无1例复发;未见再骨折发生;肢体功能基本恢复。结论异体骨联合自体骨髓移植治疗骨囊肿是一种安全有效的手术方法。     

高速磨钻在侵袭性骨肿瘤治疗中的应用

目的：探讨高速磨钻在治疗侵袭性骨肿瘤治疗中的作用。方法：2000年4月～2001年9月收治长骨侵袭性骨肿瘤病例28例，采用高速磨钻方法治疗17例。首先，开窗刮除瘤腔内肿瘤组织，然后直视下应用高速磨钻沿各个方向仔细磨除瘤腔内壁表面骨嵴，尤其是瘤腔顶部，额外磨除瘤腔皮质骨下1～5mm的骨组织，直到显露正常骨质。必要时也磨除部分软骨下骨，部分病变区域需至关节软骨平面。即使病变部位骨皮质因侵蚀破坏后变薄或已经穿破，应用高速磨钻可能钻破骨皮质，也应继续磨除残留骨皮质，达到磨除干净为止。选择非结构性移植物，包括自体髂骨或同种异体骨、碳酸化羟基磷灰石，填充骨缺损。结果：术后平均随访时间16个月(7～24个月)。无局部复发及远处脏器转移。术后关节功能轻度受限1例；切口早期炎性反应2例；深部感染1例；病变部位远侧肿胀1例。未发生继发性病理骨折。结论：侵袭性骨肿瘤腔壁在肉眼和显微镜下均可见凸凹不平的骨嵴，常刮匙并不能刮除骨嵴间的肿瘤细胞。高速磨钻对骨组织具有较强的切割作用，能较易磨平凸出的骨嵴，虽然仍为病灶内手术，但应用高速磨钻后扩大了手术切除的范围，可以达到边缘切除的效果，保证手术的彻底性。高速磨钻的应用是减少侵袭性骨肿瘤复发的有效手段，值得普及、推广。     

刮除植骨治疗骨巨细胞瘤的临床研究

目的:通过刮除植骨对骨巨细胞瘤刮除后骨缺损重建的效果分析,了解自体骨或异体骨移植后局部复发率和并发症发生情况。方法:随访手术治疗72例骨巨细胞瘤,男31例,女41例;年龄14～66岁,平均32.4岁。主要发病部位为股骨上端5例,股骨下端21例,胫骨上端17例,肱骨上端7例及桡骨远端9例。外科治疗以X线Cam-panacci分级系统或Enneking外科分期标准为原则,采用囊内刮除植骨(病灶刮除术和肿瘤瘤段切除术),对肿瘤切除,进行临床和放射学随访。结果:72例中有53例获得随访,随访时间8～48个月,平均2年4个月。功能评价按Ennek-ing标准,本组优25例,良21例,一般5例,优良率90.19%。结论:本研究提示骨巨细胞瘤刮除后行骨移植修复骨缺损、重建关节,手术刮除彻底,复发率低,植骨愈合可靠,重建后的关节功能良好,可能与肿瘤充分刮除有关。     

高速磨钻在侵袭性骨肿瘤治疗中的应用

目的：探讨高速磨钻在治疗侵袭性骨肿瘤治疗中的作用。方法：首先开窗刮除瘤腔内肿瘤组织，然后直视下应用高速磨钻沿各个方向仔细磨除瘤腔内壁表面骨嵴，尤其是瘤腔顶部，额外磨除瘤腔皮质骨下1～5mm的骨组织，直至显露正常骨质。必要时也磨除部分软骨下骨，部分病变区域需至关节软骨平面。选择非结构性移植物，包括自体髂骨或同种异体骨、碳酸化羟基磷灰石，填充骨缺损。结果：术后平均随访时间27个月(7～41个月)。3例局部复发，无远处脏器转移。术后关节功能轻度受限1例；切口早期炎性反应2例；深部感染1例；病变部位远侧肿胀1例。未发生继发性病理骨折。结论：高速磨钻对骨组织具有较强的切割作用，能较易磨平凸出的骨嵴，虽然仍为病灶内手术，但应用高速磨钻后扩大了手术切除的范围，可以达到边缘切除的效果，保证手术的彻底性。