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涉及良性骨肿瘤的病理性骨折后股骨近端的挽救治疗

Salvage of the proximal femur following pathological fractures involving benign bone tumors.

作者信息

Carvallo Pedro I, Griffin Anthony M, Ferguson Peter C, Wunder Jay S

机构信息

University Post-Graduate Orthopaedic Oncology Program, Universidad Central de Venezuela, Servicios Oncológicos Hospitalarios, Seguro Social, Caracas, Venezuela.

University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada.

出版信息

J Surg Oncol. 2015 Dec;112(8):846-52. doi: 10.1002/jso.24072. Epub 2015 Oct 19.

Abstract

BACKGROUND AND OBJECTIVES

To describe the surgical treatment of patients with a pathologic fracture through a benign tumor of the proximal femur to determine if there is a difference in local recurrence, complications or functional outcome compared to patients with tumors in the same location without pathologic fractures.

METHODS

From 1989-2010, of 97 patients, 29 presented with a pathologic fracture (PF) through a proximal femoral benign bone tumor and 68 presented without a pathologic fracture (NPF). Outcomes of the two groups were compared in terms of surgical management, postoperative complications, local recurrence and functional scores.

RESULTS

Fibrous dysplasia, giant cell tumor of bone and chondroblastoma were the most common subtypes. Most patients were managed with joint preservation in both PF (86.2%) and NPF (98.5%) groups (P = 0.03). Local recurrence risk was similar for patients in the PF (10.3%) and NPF (8.8%) groups. Mean follow-up was 105.7 months (P = 0.8). Functional outcome scores were high in both groups and not statistically significantly different.

CONCLUSIONS

The majority of pathologic fractures through a benign bone tumor of the proximal femur can be successfully treated with curettage, burring, bone grafting and internal fixation without increasing the risk of local recurrence or negatively impacting functional outcome.

摘要

背景与目的

描述股骨近端良性肿瘤所致病理性骨折患者的手术治疗情况,以确定与同一部位无病理性骨折的肿瘤患者相比,在局部复发、并发症或功能结局方面是否存在差异。

方法

1989年至2010年,97例患者中,29例因股骨近端良性骨肿瘤出现病理性骨折(PF),68例未出现病理性骨折(NPF)。比较两组在手术治疗、术后并发症、局部复发及功能评分方面的结局。

结果

纤维发育不良、骨巨细胞瘤和成软骨细胞瘤是最常见的亚型。PF组(86.2%)和NPF组(98.5%)大多数患者采用保留关节治疗(P = 0.03)。PF组(10.3%)和NPF组(8.8%)患者的局部复发风险相似。平均随访105.7个月(P = 0.8)。两组功能结局评分均较高,且无统计学显著差异。

结论

大多数股骨近端良性骨肿瘤所致病理性骨折可通过刮除、打磨、植骨及内固定成功治疗,且不增加局部复发风险或对功能结局产生负面影响。

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