儿童股骨近端骨肿瘤的手术治疗

Surgical Treatment for Proximal Femoral Tumors in Children

目的:总结儿童股骨近端骨肿瘤手术治疗的经验教训。方法:37例14岁以下的患者接受不同方式的手术治疗,平均随访37.2个月。结果:病变刮除、瘤壁残留肿瘤组织灭活、植骨术仍是目前治疗良性病变常用的手术方法,应避免损伤股骨头骨骺。对病灶范围较大伴有髋内翻畸形的良性病变,行病变部分刮除、外翻截骨及内固定后可维持正常的颈干角和髋关节功能。瘤段切除、长柄人工股骨头置换术,是修复股骨近端恶性骨肿瘤切除后大块骨缺损的一种较好的方法,具有早期恢复肢体功能、并发症少、材料来源充足等优势。结论:儿童股骨近端骨肿瘤的手术治疗应考虑到病变的性质、侵袭范围、股骨近端的应力分布及儿童骨骺未闭合等特点,采用适当的术式,多可获得良好的效果。

Objective: To study the surgical treatment for proximal femoral tumors in children. Methods: Thirty-seven patients aged 5 to 14 years undergone operations were followed up(median 37. 2 months). Results: Of all the 37 patients, there were 32 cases of benign lesions,5 cases of malignant lesions. Curettage and bone grafting were safe and main treatment for most of benign lesions. Fibrous dysplasia of the bone and giant cell tumor of bone would result in progressive varus deformity and/or fracture, and the common curettage and bone grafting were not successful; valgus osteotomy and fixation by interlocked in-tramedullary nails would have better result,but internal fixation device shoule not be extended cross the level of the epiphysis. The use of bone grafting with metallic protheses for the treatment of proximal femoral tumors can be applied with good results in selected patients having limb salvage surgery. There were 4 cases of local tumor recurrence and 6 cases of bone grafting re-sorbed. Conclusion: Good results can be obtained in most patients when the surgical treatment principals are considered according to the type,location and the extent of tumor and the features of bone in children.