Jiang Jimmy J, Hussain Waqas M, Bielski Robert J
Department of Orthopaedics, University of Chicago Medical Center, Chicago, Illinois 60637-1470, USA.
Orthopedics. 2012 Oct;35(10):e1533-6. doi: 10.3928/01477447-20120919-25.
Avascular necrosis of the femoral condyle is an uncommon but serious sequela in patients who have received chemotherapy or corticosteroid treatment. The optimal treatment of avascular necrosis of the femoral condyles in pediatric patients is not well established. Nonoperative management has had limited long-term success, and many of the surgical procedures available for adults, including core decompression, osteotomy, and femur resurfacing, are undesirable in skeletally immature patients with open physes.This article describes a case of a 7-year-old girl with acute lymphocytic leukemia who developed avascular necrosis of the lateral femoral condyle that was treated with bone impaction grafting. The patient experienced right knee pain and swelling shortly after the initiation of chemotherapy. The radiological studies obtained showed subchondral collapse of the lateral femoral condyle. After a course of nonoperative management failed to improve symptoms, she underwent bone impaction allografting of the lateral femoral condyle using a physis-sparing approach. More than 5 years postoperatively, she has achieved excellent clinical results. Postoperative imaging of the knee has also confirmed good integration of the bone graft, an open physis, and preservation of the articular surface. This technique is a relatively less invasive surgical procedure for the treatment of avascular necrosis of the femoral condyle in a pediatric patient.
股骨髁无血管性坏死是接受化疗或皮质类固醇治疗患者中一种罕见但严重的后遗症。小儿股骨髁无血管性坏死的最佳治疗方法尚未明确。非手术治疗长期成功率有限，许多适用于成人的手术方法，包括髓芯减压、截骨术和股骨表面置换术，对于骨骼未成熟且骨骺开放的患者并不适用。本文描述了一名7岁急性淋巴细胞白血病女孩发生外侧股骨髁无血管性坏死并接受骨冲击植骨治疗的病例。患者在化疗开始后不久出现右膝疼痛和肿胀。影像学检查显示外侧股骨髁软骨下塌陷。经过一个疗程的非手术治疗未能改善症状后，她采用保留骨骺的方法对外侧股骨髁进行了骨冲击同种异体植骨。术后5年多来，她取得了优异的临床效果。膝关节术后影像学检查也证实了骨移植的良好整合、开放的骨骺以及关节面的保留。该技术是一种治疗小儿患者股骨髁无血管性坏死的相对微创的手术方法。
