Central South University, Xiangya Hospital, Department of Orthopaedics, Changsha, China.
Central South University, Second Xiangya Hospital, Department of Spine Surgery, Changsha, China.
Bone Joint J. 2019 Jun;101-B(6):732-738. doi: 10.1302/0301-620X.101B6.BJJ-2018-1599.R1.
The aim of this study was to evaluate the efficacy of the surgical dislocation approach and modified trapdoor procedure for the treatment of chondroblastoma of the femoral head.
A total of 17 patients (ten boys, seven girls; mean age 16.4 years (11 to 26)) diagnosed with chondroblastoma of the femoral head who underwent surgical dislocation of the hip joint, modified trapdoor procedure, curettage, and bone grafting were enrolled in this study and were followed-up for a mean of 35.9 months (12 to 76). Healing and any local recurrence were assessed via clinical and radiological tests. Functional outcome was evaluated using the Musculoskeletal Tumour Society scoring system (MSTS). Patterns of bone destruction were evaluated using the Lodwick classification. Secondary osteoarthritis was classified via radiological analysis following the Kellgren-Lawrence grading system. Steinberg classification was used to evaluate osteonecrosis of the femoral head.
The epiphyseal plate was open, closing, and closed in five, five, and seven patients, respectively. In total, eight, six, and three patients were classified as having Lodwick classification IA, IB, and IC, respectively. Allogeneic and autogenous bone grafting was used in 13 and four patients, respectively. All patients had good bone healing and no local recurrence was observed. One patient developed osteonecrosis of the femoral head (Steinberg IA) and one developed secondary osteoarthritis of the hip joint (Kellgren-Lawrence Grade II). The mean postoperative MSTS functional score was 27.7 (24 to 30).
Surgical dislocation and modified trapdoor procedures are safe and effective techniques for treating chondroblastoma in the femoral head. Cite this article: 2019;101-B:732-738.
本研究旨在评估髋关节脱位入路联合改良揭盖术治疗股骨头软骨母细胞瘤的疗效。
本研究共纳入 17 例（男 10 例，女 7 例；平均年龄 16.4 岁[11～26 岁]）经髋关节脱位、改良揭盖术、刮除、植骨治疗的股骨头软骨母细胞瘤患者，平均随访 35.9 个月[12～76 个月]。通过临床和影像学检查评估愈合情况和局部复发情况。采用肌肉骨骼肿瘤学会评分系统（MSTS）评估功能结局。采用 Lodwick 分类评估骨破坏模式。采用 Kellgren-Lawrence 分级系统对继发髋关节骨关节炎进行放射学分析分类。采用 Steinberg 分类评估股骨头坏死。
骺板分别为开放型、即将闭合型和闭合型 5、5、7 例。Lodwick 分类分别为 IA、IB、IC 型 8、6、3 例。异体骨和自体骨植骨分别为 13、4 例。所有患者均有良好的骨愈合，无局部复发。1 例发生股骨头坏死（Steinberg IA 型），1 例发生髋关节继发骨关节炎（Kellgren-Lawrence Ⅱ级）。术后平均 MSTS 功能评分为 27.7 分[24～30 分]。
髋关节脱位联合改良揭盖术是治疗股骨头软骨母细胞瘤安全有效的方法。
Zhong G, Chen J, Zheng H, et al. Surgical dislocation and modified trapdoor procedures for the treatment of chondroblastoma of the femoral head: a minimum 3-year follow-up study. Bone Joint J. 2019;101-B:732-738.
