Song Jiashi, Liu Bing, Jin Kaipeng, Yao Quan
Department of Orthopedics, Zhejiang Rongjun Hospital, Nanhu District, Jiaxing, Zhejiang, PR China.
Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China.
Medicine (Baltimore). 2024 Dec 13;103(50):e40960. doi: 10.1097/MD.0000000000040960.
We first report a unique case of proximal femoral Giant cell tumor of bone, a subtrochanteric lesion associated with femoral neck and intertrochanteric involvement. We chose a completely new surgical approach to treat the primary tumor and preserve the hip joint. No cases of this type have ever been reported.
The patient, a 26-year-old man, came to our hospital for treatment of right hip pain more than 4 months ago, had no family history of similar diseases.
Based on the imaging results and pathology, a diagnosis of Giant cell tumor of bone was confirmed.
Based on the imaging grade and patients' wishes, the tumor managed by extended curettage and reconstructed with a fibular strut allograft and long intramedullary interlocking nail was used for prophylactic fixation of fractures. The patient did not undergo disuzumab.
After 40 months of follow-up, although the bone defect finally reached bone healing, the hip function was good, and the tumor did not recur, there were signs of internal fixation loosening at 12 months of the surgery.
For young patients with imaging grade <3 who need limb salvage, fibular strut allograft and intramedullary nail-fixation are also an alternative treatment option for hip reconstruction after tumor surgery when the lesion involves the entire proximal femur.
我们首次报告了一例独特的股骨近端骨巨细胞瘤病例，这是一种与股骨颈和转子间受累相关的转子下病变。我们选择了一种全新的手术方法来治疗原发性肿瘤并保留髋关节。此前从未有过此类病例的报道。
该患者为一名26岁男性，4个多月前因右髋疼痛前来我院就诊，无类似疾病家族史。
根据影像学结果和病理检查，确诊为骨巨细胞瘤。
根据影像学分级和患者意愿，采用扩大刮除术治疗肿瘤，并用腓骨支撑异体骨和长髓内交锁钉进行重建，以预防骨折。患者未接受地舒单抗治疗。
经过40个月的随访，尽管骨缺损最终实现了骨愈合，髋关节功能良好，肿瘤未复发，但在术后12个月时出现了内固定松动的迹象。
对于影像学分级<3且需要保肢的年轻患者，当病变累及整个股骨近端时，腓骨支撑异体骨移植和髓内钉固定也是肿瘤手术后髋关节重建的一种替代治疗选择。
