病灶清除植骨辅以小儿髋部锁定加压接骨板固定治疗儿童股骨颈瘤样病变的疗效

Evaluation of curettage and bone grafting combined with locking compression pediatric hip plate in the treatment of tumor-like lesions of femoral neck in children

目的分析儿童股骨颈瘤样病变在进行病灶清除植骨治疗过程中应用小儿髋部锁定加压接骨板(LCP-PHP)固定的疗效。方法回顾性分析2012年1月至2019年6月南京医科大学附属儿童医院收治的Erol分型为Ⅱ~Ⅳ型股骨颈瘤样病变45例患儿的资料,其中男32例,女13例;年龄2~14岁;单纯性骨囊肿27例,骨纤维结构不良15例,朗格汉斯组织细胞增生症3例;其中合并病理性骨折17例。无病理性骨折患儿根据手术方式不同分为病灶清除植骨+LCP-PHP预防固定组(A组)和病灶清除植骨组(B组)。伴病理性骨折患儿根据手术方式不同分为病灶清除植骨+复位LCP-PHP固定组(C组)和病灶清除植骨组(D组)。比较A组与B组患儿术后颈干角丢失、病灶愈合情况、愈合时间及末次随访骨骼肌肉肿瘤学会(MSTS)功能评分。分别比较C组、D组术后1 d和末次随访患侧颈干角变化。结果45例患儿均获得随访,随访时间1~4年,平均2.6年。A组术后颈干角丢失(0.50±0.45)°,B组术后颈干角丢失(2.26±1.64)°,差异有统计学意义(t=-3.193,P<0.05);病灶愈合情况、愈合时间及末次随访MSTS评分差异均无统计学意义(均P>0.05)。C组术后1 d患侧颈干角为(133.67±4.53)°,末次随访患侧颈干角为(133.00±4.32)°,差异无统计学意义(P>0.05)。D组术后1 d患侧颈干角为(133.36±7.82)°,末次随访患侧颈干角为(130.63±8.24)°,差异有统计学意义(t=7.11,P<0.05)。结论在治疗儿童ErolⅡ~Ⅳ型股骨颈瘤样病变过程中,应用LCP-PHP固定能有效维持颈干角,预防病理性骨折的发生。

Objective To analyze the curative effect of locking compression pediatric hip plate(LCH-PHP)in the treatment tumor-like lesions of femoral neck in children.Methods From January 2012 to June 2019,45 children with Erol type Ⅱ-Ⅳ tumor-like lesions of femoral neck were retrospectively analyzed,involving 32 males and 13 females,aged 2-14 years.Among them,27 cases were simple bone cyst,15 cases were fibrous dysplasia,3 cases were Langerhans histiocytosis,and 17 cases were accompanied with pathological fracture.Patients without pathological fracture were divided into 2 groups according to different surgical methods:lesion removal and bone grafting+LCH-PHP preventive fixation group(group A)and lesion removal and bone grafting group(group B).Patients with pathological fracture were divided into 2 groups according to the different surgical methods:lesion removal and bone grafting+LCH-PHP fixation and reduction group(group C)and lesion removal and bone grafting group(group D).The loss of femoral neck-stem angle,healing time and Musculoskeletal Tumor Society(MSTS)scores were compared between group A and group B.Changes of femoral neck-stem angle were compared between group C and group D at postoperative 1 day and the last follow-up.Results Forty-five patients were followed up for an average of 2.6(1-4)years.The loss of femoral neck-stem angle in group A and group B were(0.50±0.45)°,and(2.26±1.64)°,which was significantly different(t=-3.193,P<0.05).There were no significant differences in the healing condition,healing time and MSTS scores at the last follow-up between group A and group B(all P>0.05).In group C,the ipsilateral femoral neck-stem angle at the postoperative 1 day and the last follow-up were(133.67±4.53)°and(133.00±4.32)°,respectively,which was comparable(P>0.05).In group D,the ipsilateral femoral neck-stem angle at the postoperative 1 day and the last follow-up were(133.36±7.82)°and(130.63±8.24)°,respectively,which was significantly different(t=7.11,P<0.05).Conclusions LCH-PHP fixation can effectively maintain the femoral neck-stem angle and prevent the occurrence of pathological fracture children with Erol Ⅱ-Ⅳ tumor-like lesions of femoral neck.