儿童股骨近端良性骨肿瘤病理骨折的手术治疗

Surgical treatment for children pathological fractures secondary to benign bone tumor of proximal femur

目的报告23例儿童股骨近端良性骨肿瘤所致病理性骨折的特征和手术治疗经验。方法我科1990年1月至2007年12月收治的167例14岁以下儿童股骨近端良性骨肿瘤中23例伴有病理性骨折,占总例数的13.7%。23例中孤立性骨囊肿15例,骨的纤维结构不良5例,骨巨细胞瘤1例,动脉瘤样骨囊肿2例,其中2例为陈旧性骨折。23例均经病灶内切除和内固定手术治疗,平均随访时间38.2个月。手术采用病灶刮除、50%氯化锌烧灼骨壁、异体骨粒或磷酸三钙人工骨粒充填骨腔,骨折均采用内固定治疗,病灶范围较大、骨壁破碎严重的Ⅲ型骨折使用髓内固定,其他采用钢板固定。结果 1例骨的纤维结构不良患儿手术后5年复发,其余均达到满意的临床骨愈合,未见内固定断裂、感染等并发症。结论儿童股骨近端良性骨肿瘤所致病理性骨折因骨质薄弱往往破碎严重,所在部位邻近髋关节,使外科治疗面临许多困难。尽管骨折破坏明显,但骨膜等成骨结构一般保存完好,为肿瘤的病灶内切除后的骨重建提供了先决条件。手术设计时对病灶性质、范围、骨骺生长发育等问题应全面考虑,合理使用内固定,可获得满意治疗效果。

Objective To report the feature and surgical experience of the treatment for children pathological fractures secondary to benign bone tumor of proximal femur. Methods From January 1990 to December 2007, 167 cases under the age of 14 years were treated in our department and among them pathological fractures occurring in the proximal femur secondary to benign bone tumor happened in 23 cases taking up 13.7% of the amount of the total cases. In the 23 cases, 15 cases were of solitary bone cyst, 5 cases were of fibrous dysplasia of bone, 1 case was of giant cell tumor of bone and 2 cases were of aneurysmal bone cyst. 2 cases were of old fracture in 23 cases. All 23 cases were treated surgically using intra-lesional excision and internal fixation. The mean follow-up period was 38.2 months. Lesional excision, cauterization of bone wall with 50% concentration ZnC12, filling of bone cavity with allograft or novel interporous TCP bone graft were applied. Internal fixation was applied to treat bone fracture. Intramedullary fixation was applied to treat the type III bone fracture of comparatively wide lesion and severe smash of bone wall. Others were applied fixation of steel plate. Results Recurrence was observed in 1 case of fibrous dysplasia of bone at the fifth year after the surgery while other cases showed satisfactory clinical healing of bone. No complications existed such like breakup of internal fixation, infection and so on. Conclusions Due to the weak sclerotin, pathological fracture of the proximal femur secondary to benign bone tumor in children is usually accompanied with sever smash and the lesion location is near to the hip, which makes the surgical treatment confronted with many difficulties. Although the fracture damage is obvious, it paves the way for the bone reconstruction after the curettage of tumor lesion due to the well preserved bone wall and osteogenesis structure. Comprehensive consideration of lesion property, lesion range, osteoepiphysis growth and so on during the surgery designing and suitable internal fixation wil! obtain satisfactory treating results.