带血供腓骨移植重建股骨近端溶骨性病变致骨缺损  

Surgical treatment of invasive benign tumors and tumor- like lesions of the proximal femur

作　　者：高明暄[1] 李旭升[1] 付晓燕[1] 陈彦飞[1] 赵锟 常彦峰[1] 李生贵[1] 邵宏斌[1] 

机构地区：[1]兰州军区兰州总医院,甘肃兰州730050 [2]甘肃定西安定区西巩中心卫生院,743021

出　　处：《中国矫形外科杂志》2015年第15期1351-1355,共5页Orthopedic Journal of China

基　　金：甘肃省自然科学基金面上项目(编号:1308RJZA210);中国博士后科学基金面上项目(编号:2013M542571)

摘　　要：[目的]评价带血供游离腓骨移植重建股骨近端侵袭性良性溶骨性病变所致骨缺损的临床疗效。[方法]总结自2008年4月~2013年3月收治股骨近端良性侵袭性肿瘤或肿瘤样病变共14例,采用病灶内扩大刮除、氯化锌烧灼瘤壁,吻合血管腓骨移植,支持钢板内固定等方法手术治疗,影像学随访评价病变转归、植骨愈合;采用改良肌肉骨髂系统肿瘤学会（Musculoskeletal Tumor Society,MSTS）肢体功能评价表随访肿瘤切除术后患者肢体功能。[结果]随访18~67个月,平均（35.71±15.80）个月。其中1例骨巨细胞瘤患者于术后12个月复发。其余13例患者随访期间均未见病变复发表现,钢板固定无松动、断裂,无术后病理性骨折,未见股骨头缺血性坏死等其他并发症。移植腓骨无缺血坏死表现、与受区2~7个月骨性愈合,平均愈合时间（4.54±1.27）个月。术后3、6个月MSTS功能评分依次为（25.57±4.27）,（27.07±6.53）分。[结论]病灶刮除,氯化锌烧灼瘤壁,吻合血管腓骨移植填充重建,结合支持钢板内固定是股骨近端侵袭性良性肿瘤及瘤样病变的有效外科治疗方法。中期随访表现为病变复发率低,破坏骨结构得以重建,髋关节功能良好。[Objective] To evaluate the clinical efficacy of free vascularized fibular grafting reconstruction of bony defects in patients with invasive benign lytic lesions of proximal femur. [Methods] The modified version of Musculoskeletal Tumor Society（ MSTS） score was used to evaluate limb functions of 14 patients who underwent surgical treatments including curettage,zinc chloride burning aneurysm wall,free vascularized fibular graft and support plate fixation due to active benign proximal femoral tumors or tumor- like lesions from April 2008 to March 2013 and imaging was used in follow up to evaluate disease prognosis and bone healing. [Results] Patients were followed up for（ 35. 71 ± 15. 80） months,ranging from 18 to 67 months. One patient with giant cell tumor developed recurrence and died from lungs metastasis. The other 13 patients showed no tumor recurrence,plate loosening,fracture,postoperative pathologic fractures,vascular necrosis of fibular graft and other complications during follow- up. The grafts were healed within 2- 7 months with average healing time of（ 4. 54 ± 1. 27） months. The mean MSTS scores were（ 25. 57 ± 4. 27）,（ 27. 07 ± 6. 53） at three and six months after surgery,respectively. Limb functions were excellent. [Conclusion] Extended curettage,zinc chloride aneurysm wall,as well as vascularized fibular graft reconstruction filling together with support plate fixation are effective surgical treatments for patients with invasive benign proximal femoral tumors or tumor- like lesions. Mid- term follow- up showed low lesion recurrence rate,well rebuilt structures of destructed bones and good hip functions.

关 键 词：游离带血供腓骨 侵袭性良性骨肿瘤 瘤样病变 病灶刮除 氯化锌 股骨近端 

分 类 号：R738.1[医药卫生—肿瘤]