铰刀刮除联合自体骨搬运微创治疗股骨头颈部良性肿瘤的临床疗效分析

Analysis of the Clinical Efficacy of Minimally Invasive Treatment of Femoral Head and Neck Benign Tumor by Reaming Curettage Combined with Autogenous Bone Graft Transport

目的:探讨铰刀刮除联合自体骨搬运技术微创治疗股骨头颈部良性肿瘤的临床疗效及安全性。方法:回顾性分析长海医院骨科2012年1月至2016年1月收治的股骨头颈部良性肿瘤患者,按纳入标准筛选出52例,并分为两组。其中,对照组27名患者使用传统经外侧入路开窗病灶刮除人工骨植骨内固定,微创组25名患者用微创铰刀刮除联合自体骨搬运及人工骨植骨支具外固定。比较两组患者手术时间、出血量、住院时间、住院费用以及术后不良事件发生、骨愈合情况、术后功能恢复情况等。结果:两组均未出现感染、内固定失效、肿瘤恶变、复发、股骨头坏死等并发症,微创组出现1例病理性骨折。微创组在手术时间、术中平均出血量、平均住院天数及住院花费中均低于或短于对照组(P<0.05);微创组平均骨愈合时间短于对照组(P<0.05);微创组术后1个月及3个月Harris评分高于对照组(P<0.05),术后6个月Harris评分与对照组相当(P>0.05)。结论:采用铰刀刮除联合自体骨搬运微创治疗股骨头颈部良性肿瘤具有手术及住院时间短,术中出血少,住院费用低,骨愈合时间短以及术后早期功能恢复更好等优点,其临床疗效显著。

Objective： To evaluate the clinical efficacy of reaming curettage combined with autogenous bone graft transport in the treatment of benign tumors of the femoral head and neck. Methods： A retrospective analysis of the patients with femoral head and neck benign tumor admitted in the department of orthopaedics in Changhai Hospital from January 2012 to January 2016 was carried out. 52 cases were screened according to the inclusion criteria and divided into two groups. 27 patients in the control group were treated with traditional lateral approach, fenestration, curettage, artificial bone graft and internal fixation. 25 patients in minimally invasive group were treated with minimally invasive reamer curettage combined with autogenous bone graft and artificial bone graft and external fixator. The operation time, bleeding volume, hospitalization time, hospitalization expenses, postoperative adverse events, bone healing and postoper- ative functional recovery were compared between the two groups. Results： There was no complications such as infection, failure of internal fixation, tumor malignancy, recurrence or necrosis of the femoral head in the two groups, while there was 1 case of pathological fracture in the minimally invasive group. The minimally invasive group was superior to the control group in the average operation time, blood loss, hospitalization days and hospitalization expenses （P〈0.05）; the average bone healing time of minimally invasive group was shorter than that of the control group （P〈0.05）; The Harris score of the minimally invasive group at 1 month and 3 months after treatment were better than those of the control group （P〈0.05）, while it was equivalent to that of the control group at 6 months after operation （P〉0.05）, and all recovered well. Conclusions： The minimal invasive method of reaming curettage combined with autogenous bone graft transport in the treatment of benign tumors of the femoral head and neck has the advantage of shorter operation time, hospitalization time, less bleeding, low costs, short bone healing time and better early functional recovery. The clinical curative effect is remarkable.