股骨干良性骨肿瘤刮除植骨术后早期病理性骨折的相关因素分析

 目的 探讨股骨干良性骨肿瘤刮除植骨术后早期病理性骨折的相关因素。方法 回顾性分析2004年3月至2011年3月收治的47例经股外侧入路刮除植骨治疗股骨干良性骨肿瘤患者的资料，根据术后是否发生早期病理性骨折分组。骨折组13例，男11例，女2例；年龄16～61岁，平均42.7 岁；术后至发生骨折时间21～36 d，平均22.3 d。未骨折组34例，男23例，女11例；年龄15～60岁，平均39.1 岁。骨折与未骨折组肿瘤绝对宽度与骨干横径比值、骨窗缺损宽度与骨干矢状径的比值、骨窗缺损长宽比、骨窗缺损形态、骨肿瘤分级、致伤暴力及医嘱依从性等进行统计分析。结果 骨折组骨窗缺损长宽比平均为3.72±3.58，未骨折组平均为2.67±6.35。骨折组潜伏期患者1例、活跃期6例、侵袭期6例，未骨折组潜伏期患者21例、活跃期10例、侵袭期3例，两组比较差异均有统计学意义。骨折组4例医嘱依从性差，9例良好。肿瘤绝对宽度与骨干横径比值、骨窗缺损宽度与骨干矢状径比值、骨窗缺损形态两组比较差异无统计学意义。结论 骨窗缺损长宽比>4、肿瘤分级致切缘扩大、骨皮质损害广泛为骨折高危因素，对具备术后病理骨折高危因素的患者应予以预防性内固定。

Related-factors analysis on early pathological fracture after curettage of benign tumors in femoral shaft

Objective To discuss the related factors of early pathological fracture after curettage of benign bone tumors in femoral shaft. Methods The clinical data of 47 patients with benign bone tumors in femoral shaft, treated by curettage with bone graft via the vastus lateralis approach from March 2004 to March 2011, were retrospectively analyzed. Thirteen patients of them presented with early pathological fracture after the curettage. In fracture group, there were 13 cases, 11 males and 2 females, and the time from finishing curettage to fracture occurring ranged from 21 to 36 days. In non-fracture group, there were 34 cases, 23 males and 11 females. The following data of fracture group and non-fracture group were compared and analyzed, such as specific value of absolute width of tumor and transverse diameter of bone shaft, specific value of defect width of bone window and sagittal diameter of bone shaft, defect length-width ratio of bone window, defect morphology of bone window, classification of bone tumor, violence of causing injury and compliance to medical advice. Results The average defect length-width ratio of bone window in fracture group was 3.72?3.58, in non-fracture group was 2.67?6.35. For classification of tumor, in fracture group 1 case was in incubation period, 6 in active period, 6 in invasion period; in non fracture group 21 cases were in incubation period, 10 in active period, and 3 in invasion period. Four cases in fracture group had poor compliance to medical advice, and 9 in non-fracture group had good compliance. Between two groups, there were no statistical differences in specific value of absolute width of tumor and transverse diameter of bone shaft, specific value of defect width of bone window and sagittal diameter of bone shaft, and defect morphology of bone window. Conclusion When defect length-width ratio of bone window is larger than 4, the classification of tumor causes expanded incisal edge, and the cortical bone was damaged extensively, there are more possibilities for pathological fracture.