Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, China.
Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, China.
Injury. 2024 Mar;55(3):111068. doi: 10.1016/j.injury.2023.111068. Epub 2023 Sep 29.
Proximal femur simple bone cysts (SBCs) are rare in children, but with a risk of pathological fractures and the associated poor outcomes. This study aimed to evaluate the functional and radiographic outcomes of children with proximal femur SBCs.
38 children with proximal femur SBCs treated surgically at our department, West China hospital, were enrolled in the study. Patients were divided into two groups according to whether pathological fractures presented before treatment. The non-fracture group received treatment of open curettage, cavity electrocauterization, bone grafting, and fixation (proximal femoral plate, intramedullary nail or Kirschner wire). The pathological fracture group received the same procedures of curettage, electrocauterization, grafting, and fixation. Autogenous iliac bone grafting was done in all cases, and the artificial bone was used as a supplementary based on the size of the cavity. Postoperatively, all patients underwent hip spica or similar orthosis immobilization for six weeks and received the same rehabilitation program after the removal of hip spica. Patients were evaluated by two independent observers, including the functional results based on the Ratliff's criteria, avascular necrosis, healing rate based on the Neer scoring system, coxa vara, and premature physeal arrest. We described the good outcome in Ratliff's criteria as "Satisfactory results", and fair and poor outcomes as "Unsatisfactory results." Grade 1 and grade 2 Neer results were termed as failures in treatment, and grades 3 and 4 were considered successes and healing.
38 patients with 38 hips (18 on the left side and 20 on the right side) were evaluated, including 9 females and 29 males, with a mean age of 9.0±2.6 years old (range, 5 to 14 years). There was no significant difference between these two groups in the baseline data of gender, age, side, grafting, staging, and fixation methods. The rate of unsatisfactory functional results in the pathological fractures group was 56.3% (9/16), significantly higher than that in patients without fracture (22.7%, 5/22. p= 0.047). There was also a significant difference in avascular necrosis of the femoral head between the pathological fractures group (7/16) and the group without fracture (2/22, p=0.021). Thirty cases presented with healing, including 13 in the fractures group and 17 in the non-fracture group (p=1.000), and eight cases were graded as failures (2 cases of grade 1 and 6 cases of grade 2). There were also no significant differences between these two groups in premature physeal arrest (2 in fracture group and 1 in non-fracture group, P=0.562), and Coxa vara (3 in the fracture group and 0 in non-fracture group, P=0.066).
Pathological fracture significantly increases the risk of unsatisfactory functional results and avascular necrosis of the femoral head in patients with femoral neck SBCs. Prophylactic treatment and fixation of SBCs in weight bearing proximal femur region is better to manage without complications than managing with pathological fractures.
儿童股骨近端单纯性骨囊肿（SBC）较为罕见，但存在病理性骨折的风险，且相关结局较差。本研究旨在评估儿童股骨近端 SBC 的功能和影像学结局。
本研究纳入了华西医院骨科收治的 38 例股骨近端 SBC 患儿。根据治疗前是否发生病理性骨折，将患者分为两组。未发生骨折组接受切开刮除、电灼、植骨和固定（股骨近端钢板、髓内钉或克氏针）治疗。病理性骨折组接受相同的刮除、电灼、植骨和固定治疗。所有病例均采用自体髂骨植骨，根据骨腔大小补充人工骨。术后所有患者均采用髋人字石膏或类似支具固定 6 周，在去除髋人字石膏后接受相同的康复方案。由 2 位独立观察者进行评估，包括基于 Ratliff 标准的功能结果、股骨头缺血性坏死、基于 Neer 评分系统的愈合率、髋内翻和骺早闭。我们将 Ratliff 标准中的良好结果描述为“满意结果”，将差和不佳结果描述为“不满意结果”。Neer 分级 1 级和 2 级为治疗失败，3 级和 4 级为愈合成功。
38 例（左侧 18 例，右侧 20 例）38 髋（9 例女性，29 例男性）患儿纳入研究，平均年龄为 9.0±2.6 岁（5~14 岁）。两组在性别、年龄、侧别、植骨、分期和固定方式等基线资料方面无显著差异。病理性骨折组功能结果不满意的发生率为 56.3%（9/16），显著高于无骨折组（22.7%，5/22，p=0.047）。病理性骨折组股骨头缺血性坏死的发生率（7/16）也显著高于无骨折组（2/22，p=0.021）。30 例患儿愈合，其中骨折组 13 例，无骨折组 17 例（p=1.000），8 例患儿分级为失败（2 例 1 级，6 例 2 级）。两组患儿骺早闭的发生率（骨折组 2 例，无骨折组 1 例，p=0.562）和髋内翻（骨折组 3 例，无骨折组 0 例，p=0.066）比较差异均无统计学意义。
病理性骨折显著增加了股骨颈 SBC 患儿发生不满意功能结果和股骨头缺血性坏死的风险。对于承重股骨近端的 SBC，预防性治疗和固定优于病理性骨折处理，且不会出现并发症。
