Hashimoto Kazuhiko, Nishimura Shunji, Ito Tomohiko, Kakinoki Ryosuke, Goto Koji
Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama, Osaka 589-8511, Japan.
Medicine (Baltimore). 2025 Feb 14;104(7):e41584. doi: 10.1097/MD.0000000000041584.
Pathological fractures of benign bone tumors can be difficult to treat, and the underlying pathogenesis remains unclear. Herein, we aimed to determine preventive measures for pathological fractures in patients with benign bone tumors based on fracture outcomes. Between April 2015 and July 2023, we enrolled 18 consecutive patients with oncological pathological fractures treated at our department. Age, sex, histopathological diagnosis, site of origin, whether incisional or pathological fracture, treatment, operative time, blood loss, recurrence, and characteristics of impending and pathological fractures were examined. The median patient age was 22 years, comprising 9 males and 9 females. The pathology included bone cysts (n = 6), enchondromas (n = 5), fibrous dysplasia (n = 4), giant cell tumors (n = 2), and aneurysm bone cysts (n = 1). Six cases involved the humerus, 5 the femur, 3 the phalanges, 2 the toes, 1 the ribs, and 1 the tibia. Five and 13 cases were impending and pathological fractures, respectively. Thirteen patients underwent surgery, whereas 5 were treated conservatively. Surgical methods included curettage and artificial bone graft (n = 6); curettage and artificial bone graft plus compression hip screw fixation (n = 3); and curettage and artificial bone graft plus plate fixation, intramedullary nail, artificial head replacement, and plate fixation (n = 1 case each). The mean operative time and blood loss were 76 ± 56 minutes and 10 ± 80.1 mL, respectively. Recurrence occurred in 1 case. All impending fractures had onset in the lower extremity bones. Pathological fractures due to benign bone tumors of the lower extremities should not be overlooked as symptoms of pain.
良性骨肿瘤的病理性骨折治疗难度较大，其潜在发病机制尚不清楚。在此，我们旨在根据骨折结局确定良性骨肿瘤患者病理性骨折的预防措施。2015年4月至2023年7月，我们纳入了在我科接受治疗的18例连续性肿瘤病理性骨折患者。检查了患者的年龄、性别、组织病理学诊断、起源部位、是否为切开性或病理性骨折、治疗方法、手术时间、失血量、复发情况以及临病理性骨折的特征。患者中位年龄为22岁，其中男性9例，女性9例。病理类型包括骨囊肿（n = 6）、内生软骨瘤（n = 5）、骨纤维异常增殖症（n = 4）、骨巨细胞瘤（n = 2）和动脉瘤样骨囊肿（n = 1）。6例累及肱骨，5例累及股骨，3例累及指骨，2例累及趾骨，1例累及肋骨，1例累及胫骨。临病理性骨折和病理性骨折分别为5例和13例。13例患者接受了手术治疗，5例接受保守治疗。手术方法包括刮除术加人工骨移植（n = 6）；刮除术加人工骨移植加压髋螺钉固定（n = 3）；刮除术加人工骨移植加钢板固定、髓内钉固定、人工股骨头置换和钢板固定（各n = 1例）。平均手术时间和失血量分别为76±56分钟和10±80.1毫升。1例出现复发。所有临病理性骨折均发生于下肢骨。下肢良性骨肿瘤所致病理性骨折作为疼痛症状不应被忽视。
