良性骨囊肿所致小儿病理性股骨近端骨折的治疗及后遗症
Treatments and Sequelae of Pediatric Pathologic Proximal Femur Fractures Due to Benign Bone Cyst.
机构信息
Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
Arnold Palmer Hospital for Children Center of Orthopaedics, University of Florida College of Medicine Jacksonville, Jacksonville, FL.
出版信息
J Pediatr Orthop. 2022 Jul 1;42(6):e661-e666. doi: 10.1097/BPO.0000000000002128. Epub 2022 Mar 10.
BACKGROUND
The proximal femur is a common location for pathologic fractures in children, yet there is little published information regarding this injury. The purpose of this study was to investigate the outcomes of pediatric pathologic proximal femur fractures due to benign bone tumors.
METHODS
A retrospective review of patients treated for pathologic proximal femur fractures from 2004 to 2018 was conducted. Inclusion criteria were age below 18 years and pathologic proximal femur fracture secondary to a benign bone tumor. Patients were excluded if they had <1 year of follow-up. Medical charts and serial radiographs were reviewed for fracture classification, underlying pathology, treatment, complications, and time to fracture healing.
RESULTS
A total of 14 patients were included. Mean age was 6±3 (3 to 11) years, and mean follow-up was 44±21 (22 to 86) months. Index treatment was spica casting in 9/14 (68%) patients, while 5/14 (32%) were treated with internal fixation. Of the 9 patients initially treated with casting, 22% (2/9) required repeat spica casting at a mean of 0.6 months after index treatment, 67% (6/9) required internal fixation at a mean of 20.3 months after index treatment, and 11% (1/9) did not require revision treatment. Eighty-eight percent (8/9) of patients treated with casting required revision treatment compared with 40% (2/5) of those treated with internal fixation (P=0.05). Nonunion occurred after 1 refracture, malunion with coxa vara occurred in 2 fractures, and the remaining 11/14 (84%) fractures had a union at a mean of 4.9±3.0 months All cases of malunion occurred in patients initially treated nonoperatively. There were 19 distinct complications in 10/14 (71%) patients. The incidence of any revision surgery was 64% (9/14).
CONCLUSIONS
In this series, pediatric pathologic proximal femur fractures demonstrated prolonged time to union, high incidence of revision surgery (64%), and substantial complication rate (71%). In children with pathologic proximal femur fractures, treatment with internal fixation is recommended as this series showed a 78% failure rate of initial conservative management.
LEVEL OF EVIDENCE
Level IV.
背景
股骨近端是儿童病理性骨折的常见部位，但关于这种损伤的文献报道很少。本研究的目的是探讨良性骨肿瘤所致儿童股骨近端病理性骨折的治疗效果。
方法
对 2004 年至 2018 年期间接受病理性股骨近端骨折治疗的患者进行回顾性研究。纳入标准为年龄<18 岁且股骨近端病理性骨折继发于良性骨肿瘤。排除标准为随访时间<1 年。对病历和连续影像学检查结果进行分析，内容包括骨折分型、基础病理、治疗方法、并发症以及骨折愈合时间。
结果
共纳入 14 例患者。平均年龄为 6±3 岁（311 岁），平均随访时间为 44±21 个月（2286 个月）。9/14（68%）例患者接受了石膏外固定治疗，5/14（32%）例患者接受了内固定治疗。9 例初始接受石膏外固定治疗的患者中，22%（2/9）在初次治疗后 0.6 个月需要再次接受石膏外固定，67%（6/9）在初次治疗后 20.3 个月需要接受内固定治疗，11%（1/9）无需接受其他治疗。接受石膏外固定治疗的患者中，88%（8/9）需要接受其他治疗，而接受内固定治疗的患者中，40%（2/5）需要接受其他治疗（P=0.05）。84%（11/14）的患者骨折愈合，其中 1 例出现再骨折，2 例出现髋内翻畸形愈合，2 例出现骨折不愈合。所有的畸形愈合均发生在初次接受非手术治疗的患者中。14 例患者中，有 10 例（71%）出现 19 种不同的并发症。总的手术返修率为 64%（9/14）。
结论
本研究中，儿童股骨近端病理性骨折的愈合时间较长，需要手术返修的比例较高（64%），并发症发生率较高（71%）。对于股骨近端病理性骨折的儿童患者，建议采用内固定治疗，因为本研究中初始保守治疗的失败率高达 78%。
证据等级
IV 级。
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