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一例罕见病例报告:儿童股骨近端动脉瘤样骨囊肿病理性骨折

An Uncommon Case Report: Pathologic Fracture in a Proximal Femur Aneurysmal Bone Cyst in a Child.

作者信息

Sonkusale Aashay, Gandhi Pratik, Jadhav Deepak, Keswani Pranav

机构信息

Department of Orthopaedics, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India.

Department of Orthopaedics, Government Medical College and Hospital, Nagpur, Maharashtra, India.

出版信息

J Orthop Case Rep. 2023 Feb;13(2):51-54. doi: 10.13107/jocr.2023.v13.i02.3554.

Abstract

INTRODUCTION

Aneurysmal bone cysts (ABCs) are a group of benign, expansile, locally aggressive lesion characterized by fluid-filled cysts usually in the metaphyseal end of long bones. They usually affect children and young adults, with an atypical etiology and uncommon presentation. Treatment modalities include en bloc resection and curettage with or without bone graft or bone substitute augmentation with instrumentation, sclerosing agents, arterial embolization, and adjuvant radiotherapy.

CASE REPORT

We report a rare case of ABC with pathological fracture in the proximal femur of a 13-year-old male patient, who presented to the emergency department with severe pain in the right hip and inability to walk following trivial fall while playing. Curettage with open biopsy was performed followed by implantation with modified hydroxyapatite granules and internal fixation for the subtrochanteric fracture with pediatric dynamic hip screw and four hole plate, with a favorable outcome.

CONCLUSION

There is a lack of a standard guideline for the management on account of uniqueness of these cases; curettage with bone graft or bone substitutes in conjunction with internal fixation of associated pathologic fracture yields bony union with adequate clinical results.

摘要

引言

骨动脉瘤样囊肿(ABCs)是一组良性、膨胀性、局部侵袭性病变,其特征为通常位于长骨干骺端的充满液体的囊肿。它们通常影响儿童和年轻人,病因不典型且表现罕见。治疗方式包括整块切除、刮除术,可联合或不联合植骨或使用器械、硬化剂、动脉栓塞和辅助放疗来增加骨替代物。

病例报告

我们报告了一例罕见的13岁男性患者股骨近端骨动脉瘤样囊肿合并病理性骨折的病例,该患者因玩耍时轻微摔倒后出现右髋部剧痛且无法行走而就诊于急诊科。进行了刮除术及开放活检,随后植入改良羟基磷灰石颗粒,并使用儿童动力髋螺钉和四孔钢板对转子下骨折进行内固定,结果良好。

结论

由于这些病例的独特性,缺乏管理的标准指南;刮除术联合植骨或骨替代物并对相关病理性骨折进行内固定可实现骨愈合,并取得满意的临床效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a609/10152943/df999f43d069/JOCR-13-51-g001.jpg

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