Ma Qichao, Jin Fangchun, Li Taichun, Pei Honghong, Wang Yichen, Luo Yi, Zhang Ziming
Department of Orthopedics, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.
Department of Pediatric Orthopedics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Orthop Surg. 2025 Jul;17(7):2183-2192. doi: 10.1111/os.70083. Epub 2025 May 29.
Benign bone lesions involving the femoral head are common in pediatric populations but pose significant challenges due to anatomical complexity and the need to preserve growth plate integrity. This study aims to evaluate the efficacy of the trapdoor procedure in treating these lesions in skeletally immature patients.
From 2013 to 2023, five pediatric patients with femoral head bone lesions were identified who underwent the trapdoor procedure retrospectively. Preoperative assessments included computed tomography (CT) and magnetic resonance imaging (MRI). Follow-up spanned a mean of 37.8 ± 11.2 months, with attention to pathology, recurrence, and complications. Functional outcomes were assessed using the McKay clinical grading method.
Histological examination postoperatively confirmed Langerhans cell histiocytosis (LCH) in two patients and chondroblastoma in two others. One patient's diagnosis remained unclear, indicating only fibrous tissue cell proliferation. No recurrences were observed, but avascular necrosis (AVN) occurred in both LCH patients, necessitating revision surgery.
The trapdoor procedure is a safe and effective method for treating benign bone lesions of the femoral head in children, with attention needed for the potential of AVN.
累及股骨头的良性骨病变在儿科人群中很常见，但由于解剖结构复杂以及需要保留生长板完整性，给治疗带来了重大挑战。本研究旨在评估活板门手术治疗骨骼未成熟患者此类病变的疗效。
回顾性分析2013年至2023年期间接受活板门手术的5例患有股骨头骨病变的儿科患者。术前评估包括计算机断层扫描（CT）和磁共振成像（MRI）。随访平均时长为37.8 ± 11.2个月，重点关注病理、复发和并发症情况。采用麦凯临床分级法评估功能结局。
术后组织学检查确诊2例为朗格汉斯细胞组织细胞增多症（LCH），2例为软骨母细胞瘤。1例患者的诊断仍不明确，仅显示纤维组织细胞增生。未观察到复发情况，但2例LCH患者均发生了缺血性坏死（AVN），需要进行翻修手术。
活板门手术是治疗儿童股骨头良性骨病变的一种安全有效的方法，但需要注意AVN的可能性。
