儿童四肢长骨病理性骨折手术治疗60例

Reconstruction of long bones in children with 60 cases pathological fracture

目的总结儿童四肢长骨病理性骨折的手术治疗经验，探讨提高临床诊断和治疗水平的方法。方法2005年1月至2010年3月作者收治长骨病理性骨折患儿74例，其中60例采用手术治疗，在确诊原发疾病的同时，给予病灶彻底清除及植骨，并对骨折进行一期内固定处理。患儿出现患肢疼痛等症状的时间为1d至2年，出现病理性骨折的时间为2h至15d。均为闭合性骨折。对并发的其他部位外伤骨折或肿瘤病灶，均同期手术处理。结果所有病例术后切口均I期愈合，无植骨吸收、骨缺损不愈合、再次病理性骨折等并发症发生。54例获随访，随访时间1—4年，X线片提示肿瘤病灶及病理性骨折均愈合，愈合时间3～4个月，3例股骨骨囊肿、1例胫骨骨性纤维发育异常患儿术后1年局部病灶复发；1例股骨嗜酸性肉芽肿术后7个月复发，再次行肿瘤病灶刮除、自体髂骨植骨手术，1年后复查愈合良好；其余49例术后未见复发。根据X线片及肩、肘、髋、膝、踝等关节功能综合评价标准，疗效均为优秀。结论儿童长骨病理性骨折多见于股骨、胫骨、肱骨，彻底清除肿瘤病灶及植骨，对病理性骨折进行一期内固定是有效的治疗方法之一，预后良好，长期随访疗效满意。

Objective To investigate the reconstructive operative procedure and the therapeutic effects of long bones in children with pathological fracture. Methods From January 2005 to March 2010,74 cases of long bone pathological fractures were treated, of which 60 were treated with surgical treatment, a clear diagnosis of primary disease, while complete removal of the lesion and bone grafting, and the fractures were fixed for a pe- riod of treatment. There were 46 males and 14 females, aged from 3 to 13 years （8.7 years on average）. The course of limb pain and other symptoms was 1 days to 2 years（ 1.5 months on average）. The course of patholog- ical fractures was 2 hours to 15 days （3 days on average）. There were 55 cases caused by fail or trauma, occa- sional accident in 3 cases, 2 cases of pathological fractures discovered after the fall, the group of cases was closed fracture. In addition to pathological fracture, there were 4 cases of traumatic fracture and 8 cases of Le- sions concurrent other parts, the surgical procedures were handled over the same period. Results All incisions healed by first intention, and no related complications occurred. A total of 54 patients were followed up 1 to 4 years （2 years on average）. The X-ray films showed tumor and pathological fracture healed within 3 -4 months （3.5 months on average）. There were 3 cases of femoral bone cyst, 1 case of tibial osteofibrous dysplasia found that local recurrence after 1 year; one case of postoperative femoral tibial again found lesions underwent tumor curettage, autologous iliac bone graft surgery healing after 1 year review good. No recurrence occurred in other 49 cases. According to comprehensive assessing standard of X-ray film and functions of shoulder, elbow, hip, knee and ankle, the results of all cases were excellent. Conclusion Pathologic fracture of long bone disease of children, more common in the femur, tibia, humerus, and bone lesions were completely removed, and pathologic fractures were fixed for a period of treatment is an effective treatment, patients with good prognosis,long-term follow-up to obtain satisfactory outcome.