病灶刮除植骨联合股骨近端解剖钢板在股骨近端良性肿瘤治疗中的应用

目的:探讨病灶刮除植骨联合股骨近端解剖钢板治疗股骨近端良性肿瘤的临床疗效。方法 :自2010年1月至2014年10月,采用病灶刮除、自体髂骨或自体髂骨加同种异体骨植入及解剖钢板内固定术治疗股骨近端良性肿瘤患者30例,其中男13例,女17例;年龄12~68岁,平均42岁;病程1个月~2年,平均9个月。手术前后采用MSTS评分评价患者的下肢功能,并将末次MSTS评分与术前评分进行比较,随访时同时行X线检查,评价病灶愈合情况,并观察不良反应发生情况。结果:30例患者均获得随访,时间12~48个月,平均29个月。末次随访时MSTS评分为27.06±2.59高于术前的16.44±1.35,两组比较差异有统计学意义(P0.05)。末次随访时X线片均显示植骨融合,合并病理骨折者骨连续性恢复,内固定位置良好,无松动、变形及移位等。术后1例切口脂肪液化,1例骨巨细胞瘤患者术后13个月复发。结论:病灶刮除植骨联合股骨近端解剖钢板是治疗股骨近端肿瘤的有效方法,可以有效地控制肿瘤,缓解疼痛,改善功能并且预防病理性骨折的发生。

Application of debridement and bone autografting combined with proximal femoral anatomical plates for benign tumor in proximal femur

Objective: To explore the clinical effects of debridement and bone autografting combined with proximal femoral anatomical plate in treating benign tumor in proximal femur.Methods: From January 2010 to October 2014,30 patients with benign tumor in proximal femur were treated with debridement,autogenic ilium,autogenic ilium and allogeneic bone implant,and anatomic plate fixation. Among them,there were 13 males and 17 females aged from 12 to 68 years old with an average of 42 years old. The courses ranged from 1 month to 2 years with an average of 9 months. MSTS scoring were observed and compared before and after operation,and also applied to evaluate lower-extremity function. X-ray was examined to evaluate healing of focus. Postoperative complications were observed.Results: All patients were followed up from 12 to 48 months with an average of 29 months. MSTS score at the final following-up (27.06±2.59) was higher than preoperative (16.44±1.35),and there was significant difference(P<0.05). X-ray at the final following-up showed bone graft fusion,pathological fracture were recover consciously,internal fixation was well,no loosening,deformation and displacement occurred. One case occurred incision fat liquefaction and 1 patient with giant cell tumor of bone relapsed at 13 months after operation.Conclusion: Debridement and bone autografting combined with proximal femoral anatomical plate is an effective method in treating benign tumor in proximal femur. It could control tumor,relieve pain,promote function and prevent occurrence of pathologic fractures.