Trochanter/calcar preserving reconstruction in tumors involving the femoral head and neck

AIM: To evaluate the results of hip reconstruction with extensive excision for tumor confined to the femoral head and neck. METHODS: We designed a resection preserving the greater trochanter and lower portion of calcar femorale, and utilized conventional total hip prosthesis. We retrospectively reviewed 7 patients, who underwent a wide resection and reconstruction using conventional hip prosthesis. There were 3 men and 4 women and their mean age was 42.5 years(22 to 65 years). The histologic diagnosis of each patient was low-grade osteosarcoma, diffuse large B-cell lymphoma, liposclerosing myxofibroma, intraosseous lipoma, chondroblastoma, giant cell tumor and focal intramedullary fibrosis. RESULTS: One patient with lymphoma died due to disease dissemination at 10 mo postoperatively and the remaining 6 patients were followed for a mean of 4.7 years(3 to 6 years). All patients were able to return to their daily activities and no patient had local recurrence. No radiographic signs of loosening, wear, and osteolysis were found at the last follow-up. CONCLUSION: Trochanter/calcar-preserving resectionof the proximal femur and reconstruction using conventional total hip prosthesis, is a satisfactory treatment for tumors confined to the femoral head and neck.

股骨头坏死塌陷的预测：改良Kerboul法在MRI上的应用

背景：在MRI上测量相加坏死角度可预测股骨头坏死致髋关节塌陷的危险性。 方法：对连续33例37髋患者的早期骨坏死的髋关节进行研究。采用改良Kerboul等方法，测量正中冠状位和正中矢状位MRI上（非前后位和侧位X线片）骨坏死累及股骨头表面的弧度，计算两角度之和。基于计算的相加坏死角度的度数，将髋关节分为四组：1级（〈200°），2级（200°-249°），3级（250°-299°），4级（≥300°在初始评估后，患者被随机分入髓芯减压组或非手术组进行治疗，同时接受正规随访直至股骨头出现塌陷或至少观察5年。 结果：7例4级的髋关节和16例3级的髋关节在36个月出现了股骨头塌陷。9例2级的髋关节中的6例出现塌陷，5例1级的髋关节均未出现塌陷（10g-rank检验，p〈0．01）。研究期间，4例相加坏死角度≤190。（低风险组）的髋关节无1例出现塌陷，25例相加坏死角度≥240°（高风险组）的髋关节均出现塌陷，8例相加坏死角度界于190°-240°（中风险组）的髋关节中有4例（50％）出现塌陷。 结论：使用MRI扫描代替X线片测量Kerboul相加坏死角度评估股骨头坏死致髋关节塌陷的可能性是一种好的方法。 可信水平：预后性研究，上级。进一步可信度参见作者介绍。