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成年患者股骨远端良性及低级别恶性原发性骨肿瘤刮除术联合预防性骨固定术的适应证:病例系列

Indications for prophylactic osteosynthesis associated with curettage in benign and low-grade malignant primitive bone tumors of the distal femur in adult patients: a case series.

作者信息

Perisano Carlo, Barone Carlo, Stomeo Daniele, Di Giacomo Giulio, Vasso Michele, Schiavone Panni Alfredo, Maccauro Giulio

机构信息

Department of Geriatrics, Neuroscience and Orthopaedics, University Hospital "Agostino Gemelli", Catholic University of the Sacred Heart School of Medicine, L.go A. Gemelli 1, 00168, Rome, Italy.

Department of Internal Medicine, Division of Medical Oncology, University Hospital "Agostino Gemelli", Catholic University of the Sacred Heart School of Medicine, L.go A. Gemelli 1, 00168, Rome, Italy.

出版信息

J Orthop Traumatol. 2016 Dec;17(4):377-382. doi: 10.1007/s10195-016-0418-7. Epub 2016 Jul 9.

Abstract

BACKGROUND

The aim of the study was to evaluate whether the use of preventive osteosynthesis after curettage in benign and primitive low-grade malignant bone tumor localized in the distal femur in adult patients provides sufficient mechanical stability to the system as to allow weight-bearing and reduce the risk of postoperative fracture. Additionally, lower limb function after curettage and preventive osteosynthesis was evaluated.

MATERIALS AND METHODS

We analyzed twelve cases of benign and low-grade malignant bone lesions of the distal femur in adult patients treated in our orthopedic department between 2008 and 2011 with curettage, bone filling and preventive osteosynthesis. All patients were treated with curettage with the use of high-speed cutters, plus liquid nitrogen as local adjuvant in low-grade malignant lesions, and filling of the lesion with bone graft or allograft or acrylic cement, followed by osteosynthesis.

RESULTS

No fractures or major complications were observed; good function of the knee was observed.

CONCLUSION

We recommend preventive osteosynthesis after curettage in patients with very large lesions (>5 cm, >60 cm) or high functional requirements, in obese patients, and when local adjuvants are used.

LEVEL OF EVIDENCE

Level IV retrospective case-series study.

摘要

背景

本研究的目的是评估在成年患者股骨远端的良性和原发性低度恶性骨肿瘤刮除术后使用预防性骨固定术是否能为该系统提供足够的机械稳定性,以允许负重并降低术后骨折风险。此外,还评估了刮除术和预防性骨固定术后的下肢功能。

材料与方法

我们分析了2008年至2011年间在我院骨科接受治疗的12例成年患者股骨远端良性和低度恶性骨病变,采用刮除术、骨填充和预防性骨固定术。所有患者均使用高速切割器进行刮除术,在低度恶性病变中加用液氮作为局部辅助剂,并用骨移植、同种异体移植或丙烯酸骨水泥填充病变,随后进行骨固定术。

结果

未观察到骨折或重大并发症;观察到膝关节功能良好。

结论

我们建议在病变非常大(>5 cm,>60 cm)或功能要求高的患者、肥胖患者以及使用局部辅助剂时,在刮除术后进行预防性骨固定术。

证据级别

IV级回顾性病例系列研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/99b7/5071241/cb8ddedfa3ea/10195_2016_418_Fig1_HTML.jpg

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