中国修复重建外科杂志

中国修复重建外科杂志

经 Watson-Jones 入路动力髋螺钉内固定联合病灶刮除治疗股骨近端良性病变

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目的 探讨经 Watson-Jones 入路采用动力髋螺钉(dynamic hip screw,DHS)内固定联合病灶扩大刮除治疗股骨近端良性肿瘤及肿瘤样病变的疗效。 方法 2012 年 3 月—2016 年 12 月,采用经 Watson-Jones 入路 DHS 内固定联合病灶扩大刮除治疗股骨近端良性肿瘤及肿瘤样病变患者 20 例(21 处)。其中,男 13 例,女 7 例;年龄 11~51 岁,平均 27.8 岁。病变累及单侧股骨 19 例,双侧 1 例。病理类型:纤维结构不良 11 例,骨囊肿 2 例,动脉瘤样骨囊肿 2 例,良性纤维组织细胞瘤 2 例,骨巨细胞瘤 2 例,软骨母细胞瘤 1 例。Enneking 外科分期:除 3 例病理性骨折为 S2 期外,其余均为 S1 期。术前均无股骨近端内、外翻畸形。记录手术时间、术中出血量以及患者术后完全负重时间。随访摄 X 线片及 CT,了解植骨及 DHS 情况;采用疼痛视觉模拟评分(VAS)评价疼痛缓解情况,国际骨与软组织肿瘤协会(MSTS)评分标准评估下肢功能。 结果 手术时间 110~265 min,平均 177.1 min;术中出血量为 200~2 300 mL,平均 828.6 mL。术后发生切口浅表感染 1 例,深部感染 1 例,存在患髋不适感 1 例。患者均获随访,随访时间为 6~63 个月,平均 27.4 个月。2 例骨巨细胞瘤患者术后 2 d 达完全负重;其余患者术后 2~13 周完全负重,平均 7.2 周。末次随访时,VAS 评分为(0.19±0.51)分,与术前的(3.52±2.62)分比较,差异有统计学意义(t=5.565,P=0.000)。患者髋关节功能均恢复良好,末次随访时 MSTS 评分为(29.62±0.97)分,与术前的(23.71±8.77)分比较,差异有统计学意义(t=–3.020,P=0.007)。影像学检查示植骨均融合,融合时间为 5~12 个月,平均 8.2 个月。术后无病理性骨折、内固定物松动和断裂、股骨头缺血坏死以及关节脱位发生。随访期间无肿瘤复发、转移。 结论 经 Watson-Jones 入路充分暴露后行病灶刮除修复病损、DHS 内固定治疗股骨近端良性肿瘤及肿瘤样病变安全、有效。

Objective To explore the effectiveness of dynamic hip screw (DHS) and intralesional curettage via Watson-Jones approach in treatment of benign bone lesions of the proximal femur. Methods Between March 2012 and December 2016, 20 patients (21 lesions) with benign bone tumors or tumor like conditions of proximal femurs were treated DHS and intralesional curettage via Watson-Jones approach. Their average age was 27.8 years (range, 11-51 years), including 13 males and 7 females. The pathological diagnosis were fibrous dysplasia in 11 cases, simple bone cyst in 2 cases, aneurysmal bone cyst in 2 cases, benign fibrous histocytoma in 2 cases, giant cell tumor in 2 cases, and chondroblastoma in 1 case, including 3 pathological fractures. According to the Enneking staging system, 18 patients were in stage 1, 3 patients with pathological fractures in stage 2. There was no varus deformity or valgus deformity preoperative. The operation time, intraoperative blood loss, and time of full weight-bearing were recorded. X-ray film and CT were followed up to observe the bone graft fusion and DHS. Complications were observed. Visual analogue scale (VAS) and Musculoskeletal Tumor Society (MSTS) scoring were observed and compared before operation and at last follow-up. Results The average operation time was 177.1 minutes (range, 110–265 minutes). The average intraoperative blood loss was 828.6 mL (range, 200-2 300 mL). There was superficial incision infection in 1 case, deep incision infection in 1 case, and uncomfortableness in 1 case, respectively. All patients were followed up 6-63 months (mean, 27.4 months). The time of full weight-bearing was 2 days in 2 patients with giant cell tumor and 2 to 13 weeks with an average of 7.2 weeks in the other patients. At last follow-up, VAS and MSTS were 0.19±0.51 and 29.62±0.97, showing significant differences when compared with the values before operation (3.52±2.62 and 23.71±8.77) (t=5.565, P=0.000; t=–3.020, P=0.007 ). X-ray film showed the all bone grafts fusion with mean time of 8.2 months (range, 5-12 months). No patient sustained pathological fracture of the femur, local tumor recurrence, chronic hip pain, dislocation, or femoral head necrosis. Conclusion The treatment of benign bone lesion of the proximal femur using DHS and intralesional curettage via Watson-Jones approach is a safe and effective method.

关键词: 股骨近端; 良性骨肿瘤; Watson-Jones 入路; 病灶刮除; 动力髋螺钉; 内固定

Key words: Proximal femur; benign bone tumor; Watson-Jones approach; intralesional curettage; dynamic hip screw;  

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