Ramos-Pascua L R, Sánchez-Herráez S, Alonso-Barrio J A, Alonso-León A
Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de León, León, España.
Rev Esp Cir Ortop Traumatol. 2012 Jan-Feb;56(1):24-31. doi: 10.1016/j.recot.2011.08.003. Epub 2011 Oct 14.
To review the indication of surgical treatment of solitary proximal end of femur osteochondromas, and present our experience as regards the approach for a complete and safe resection.
A retrospective study of a series of 6 symptomatic solitary proximal end of femur osteochondromas treated by en bloc resection by means of a single anterior or posterior-lateral approach. The patients were followed up routinely, as well as contacted by telephone to find out their current status. The functional assessment was made using the Musculoskeletal Tumour Society (MSTS) scale. The main limitation of the study was the its low level of recommendation.
There were no post-operative complications and, after a mean follow of 8 years (rang:2-21 years), the clinical result was excellent or good in all cases, and there were no recurrences of the tumour.
Although some authors have proposed femur head subluxation or luxation to expose the whole of the femur neck and head to facilitate the resection of the osteochondroma and the joint exploration, in our experience, this can be avoided in the majority of cases.
Surgical treatment of solitary proximal end of femur osteochondromas is mandatory, as is the detailed pre-operative study of each case. Depending on their implantation and extension, en bloc resection can be performed by a single wide approach without the need for hip luxation.
回顾孤立性股骨近端骨软骨瘤的手术治疗指征,并介绍我们在完整、安全切除手术入路方面的经验。
对6例有症状的孤立性股骨近端骨软骨瘤患者进行回顾性研究,采用单一前侧或后外侧入路整块切除。对患者进行常规随访,并通过电话联系了解其目前状况。使用肌肉骨骼肿瘤学会(MSTS)量表进行功能评估。本研究的主要局限性在于其推荐级别较低。
术后无并发症,平均随访8年(范围:2 - 21年),所有病例临床结果均为优或良,且无肿瘤复发。
尽管一些作者提出通过股骨头半脱位或脱位来暴露整个股骨颈和股骨头,以利于骨软骨瘤的切除和关节探查,但根据我们的经验,大多数情况下可以避免这种情况。
孤立性股骨近端骨软骨瘤必须进行手术治疗,对每个病例进行详细的术前研究也同样必要。根据其植入和扩展情况,可通过单一广泛入路进行整块切除,无需髋关节脱位。