Tomaszewski Ryszard, Rutz Erich, Mayr Johannes, Dajka Jerzy
Department of Pediatric Traumatology and Orthopedics, Silesian Medical University, Katowice, Poland.
Institute of Biomedical Engineering, Faculty of Science and Technology, University of Silesia, Katowice, Poland.
Arch Orthop Trauma Surg. 2022 Apr;142(4):615-624. doi: 10.1007/s00402-020-03687-x. Epub 2020 Nov 24.
Benign lesions of the proximal femur region, such as simple bone cysts, aneurysmal bone cysts, and fibrous dysplasia, are common in children. Benign lesions may cause pathologic fractures, limb length inequities, and growth disturbances. Differential diagnoses, e.g., malignant bone tumors and osteomyelitis, are sometimes difficult to rule out.
We aimed to evaluate outcomes in children with benign lesions of the proximal femur treated with curettage, bone grafting, and plate fixation.
In this retrospective study, we included 30 children (median age 10.5 years; range 1.1-17.8 years) suffering from bone cysts and tumor-like lesions of the proximal femur region treated between 2002 and 2018. We analyzed plain X-ray images and CT scans in all children and obtained MRI scans in a selected group of children (63.3%). We examined histopathologic biopsy results for all bone lesions before initiating treatment. Surgical management comprised tumor curettage with adjuvant high-speed drilling and allogenic bone grafting supplemented by bone graft substitutes before plate fixation. Median follow-up interval was 87 months (range 24-156 months). We evaluated the healing of lesions according to Capanna's classification and rated functional outcomes according to Merle d'Aubigné and Postel score.
Overall, 25 of 30 (83.3%) patients were admitted to hospital because of a pathologic fracture. We diagnosed simple bone cysts in 15 (50.0%) patients, aneurysmal bone cysts in 7 (23.5%) patients, and fibrous dysplasia in 8 (26.5%) patients. Bone consolidation was achieved in 22 of 30 (73.3%) patients after a mean of 5 months (range 3-7 months). The main complication was recurrence of the lesion in 4 of 30 (13.3%) patients. With respect to the Merle d'Aubigné and Postel scores, 17 of 30 (56.7%) patients obtained an excellent result (18 points), while 12 (40.0%) patients had a good result (15-17 points) and only 1 (3.3%) patient had a fair result (14 points).
Surgical treatment of bone cysts and tumor-like lesions of the proximal femur by local resection or destruction of the lesion, followed by filling the defect with bone graft material and internal stabilization represents a safe and effective treatment option in children.
Therapeutic, retrospective comparative study-Level III.
股骨近端区域的良性病变，如单纯骨囊肿、骨动脉瘤性囊肿和骨纤维发育不良，在儿童中很常见。良性病变可能导致病理性骨折、肢体长度不等和生长障碍。鉴别诊断，例如恶性骨肿瘤和骨髓炎，有时难以排除。
我们旨在评估采用刮除术、植骨术和钢板固定治疗的股骨近端良性病变患儿的治疗效果。
在这项回顾性研究中，我们纳入了2002年至2018年间接受治疗的30例股骨近端区域骨囊肿和肿瘤样病变患儿（中位年龄10.5岁；范围1.1 - 17.8岁）。我们分析了所有患儿的X线平片和CT扫描，并对部分患儿（63.3%）进行了MRI扫描。在开始治疗前，我们检查了所有骨病变的组织病理学活检结果。手术治疗包括肿瘤刮除、辅助高速钻孔、异体骨移植，并在钢板固定前补充骨移植替代物。中位随访时间为87个月（范围24 - 156个月）。我们根据卡潘纳分类法评估病变的愈合情况，并根据默尔·德·奥贝涅和波斯泰尔评分对功能结果进行评分。
总体而言，30例患儿中有25例（83.3%）因病理性骨折入院。我们诊断出15例（50.0%）为单纯骨囊肿，7例（23.5%）为骨动脉瘤性囊肿,8例（26.5%）为骨纤维发育不良。30例患儿中有22例（73.3%）在平均5个月（范围3 - 7个月）后实现了骨愈合。主要并发症是30例患儿中有4例（13.3%）病变复发。关于默尔·德·奥贝涅和波斯泰尔评分，30例患儿中有17例（56.7%）获得了优异结果（18分），12例（40.0%）获得了良好结果（15 - 17分），只有1例（3.3%）获得了中等结果（14分）。
通过局部切除或破坏股骨近端的骨囊肿和肿瘤样病变，随后用骨移植材料填充缺损并进行内固定的手术治疗，是儿童一种安全有效的治疗选择。
治疗性回顾性比较研究 - III级。
