Panchwagh Yogesh, Joshi Sujit K, Sancheti Parag K
Department of Orthopaedic Oncology, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India.
Department of Orthopaedic Oncology, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
Indian J Orthop. 2018 Jan-Feb;52(1):51-57. doi: 10.4103/ortho.IJOrtho_209_17.
Benign aggressive bone lesions of the femoral head and neck are mostly seen in young adults and warrant treatment for pain, impending fracture or established fracture, and disease clearance. It becomes challenging to treat them effectively while attempting salvage of the femoral head and yet achieving long term disease control with minimum complications. We describe our technique and experience in dealing with these lesions which can achieve the above-mentioned goals and can be easily replicated.
We analyzed 15 cases of surgically treated, biopsy-proven benign, locally aggressive lesions affecting the femoral head and neck in skeletally mature individuals. All cases were treated with extended curettage through anterolateral modified Smith-Petersen approach along with tricortical iliac crest bone graft (combined with fibular graft in some cases) reconstruction with or without suitable internal fixation.
All, except one, patients were available for follow up. The age ranged from 18 to 43 years and the follow up ranged between 24 and 124 months (average 78 months). These included aneurysmal bone cysts (9), giant cell tumors (4), and fibrous dysplasia (2). The indication was pain (8), with impending (2) or established pathological neck femur fracture (5). In all cases, there was satisfactory healing of lesion and timely rehabilitation. Nonunion, avascular necrosis or local recurrences were not seen. The MSTS functional score was good or excellent in all (range 26-29, average 28).
Benign aggressive lesions affecting femoral head and neck in young and middle-aged adults pose a treatment challenge. A sturdy, lasting reconstruct with acceptable functional outcome and minimal recurrence rate can be achieved by salvaging the femoral head and neck using curettage and reconstruction, obviating the need for replacement at such an early age.
股骨头和颈部的良性侵袭性骨病变多见于年轻人，因疼痛、有骨折风险或已发生骨折以及疾病清除等原因需要进行治疗。在试图挽救股骨头的同时有效治疗这些病变，并以最少的并发症实现长期疾病控制，变得具有挑战性。我们描述了我们处理这些病变的技术和经验，该技术可以实现上述目标，并且易于复制。
我们分析了15例经手术治疗、活检证实为良性、局部侵袭性病变累及骨骼成熟个体的股骨头和颈部的病例。所有病例均通过前外侧改良Smith-Petersen入路进行扩大刮除术，并采用三皮质髂嵴骨移植（部分病例联合腓骨移植）进行重建，同时或不进行合适的内固定。
除1例患者外，所有患者均接受了随访。年龄范围为18至43岁，随访时间为24至124个月（平均78个月）。这些病变包括骨囊肿（9例）、骨巨细胞瘤（4例）和骨纤维异常增殖症（2例）。手术指征为疼痛（8例），有骨折风险（2例）或已发生病理性股骨颈骨折（5例）。所有病例病变均愈合良好，康复及时。未出现骨不连、缺血性坏死或局部复发。所有患者的MSTS功能评分均为良好或优秀（范围为26 - 29分，平均28分）。
中青年患者股骨头和颈部的良性侵袭性病变带来了治疗挑战。通过刮除和重建挽救股骨头和颈部，可以实现坚固、持久的重建，获得可接受的功能结果和最低的复发率，避免在如此年轻的年龄进行置换。
