Erol Bulent, Topkar Mert Osman, Aydemir Ahmet Nadir, Okay Erhan, Caliskan Emrah, Sofulu Omer
Orthopedics and Traumatology Department, Marmara University Hospital, Fevzi Cakmak Mh. Muhsin Yazicioglu Cd. No:10 34899 Ust Kaynarca, Pendik, Istanbul, Turkey.
Arch Orthop Trauma Surg. 2016 Aug;136(8):1051-61. doi: 10.1007/s00402-016-2486-9. Epub 2016 Jun 17.
We aimed to develop a surgical treatment strategy for benign bone lesions of the proximal femur based upon retrospective review of our data in 62 children.
Sixty-two children [38 male, 24 female; median age 9 years (range 5-18 years)] with proximal femoral benign bone lesions were surgically treated between 2005 and 2013. Histopathological diagnoses were simple (31) or aneurysmal (27) bone cysts, and nonossifying fibromas (4). The pathological fracture rate was 77.4 %. Surgical treatment was determined due to four criteria, including patient's skeletal maturity, localization and initial diagnosis of lesion, and amount of bone loss in the femoral neck and lateral proximal femur. Surgical procedure consisted of biopsy, curettage, bone grafting, and internal fixation when required. The median follow-up was 45 months (range 25-89 months).
Complete clinical recovery was achieved in 56 (90.3 %) patients between 4 and 8 months postoperatively; full weight-bearing and mobilization, without pain and limping, was possible. The median preoperative and postoperative last follow-up Musculoskeletal Tumor Society (MSTS) scores were 13.3 % (range 10-23.3 %) and 96.6 % (range 90-100 %), respectively (p < 0.0001). The pathological fractures were healed in 10 weeks on average (range 8-12 weeks). Fifty-seven (92 %) patients demonstrated complete or significant partial radiographic healing between 5 and 7 months that maintained throughout follow-up. Local recurrence was not observed, and only 1 (1.6 %) patient required reoperation for partial cyst healing. There were 5 (8 %) complications, 1 (1.6 %) of which required reoperation.
This treatment strategy can provide good local control and excellent functional and radiological results in the management of benign bone lesions of the proximal femur in children.
通过对62例儿童患者的数据进行回顾性分析，旨在制定一种针对股骨近端良性骨病变的手术治疗策略。
2005年至2013年间，对62例股骨近端良性骨病变患儿[38例男性，24例女性；中位年龄9岁（范围5 - 18岁）]进行了手术治疗。组织病理学诊断为单纯性骨囊肿（31例）或动脉瘤样骨囊肿（27例），以及非骨化性纤维瘤（4例）。病理骨折发生率为77.4%。根据四个标准确定手术治疗方案，包括患者的骨骼成熟度、病变的定位和初始诊断，以及股骨颈和股骨近端外侧的骨丢失量。手术步骤包括活检、刮除、植骨，并在必要时进行内固定。中位随访时间为45个月（范围25 - 89个月）。
56例（90.3%）患者在术后4至8个月实现了完全临床康复；能够完全负重和活动，无疼痛和跛行。术前和术后末次随访时肌肉骨骼肿瘤学会（MSTS）评分的中位数分别为13.3%（范围10 - 23.3%）和96.6%（范围90 - 100%）（p < 0.0001）。病理骨折平均在10周内愈合（范围8 - 12周）。57例（92%）患者在5至7个月时显示完全或显著的部分影像学愈合，并在整个随访过程中保持。未观察到局部复发，只有1例（1.6%）患者因部分囊肿愈合需要再次手术。有5例（8%）并发症，其中1例（1.6%）需要再次手术。
这种治疗策略在儿童股骨近端良性骨病变的管理中可提供良好的局部控制以及出色的功能和影像学结果。
