158例股骨近端病变的外科治疗方法  

Surgical Treatments of Proximal Femoral Lesions in 158 Cases

作　　者：张军良[1,2] 周光新[2] 樊根涛[2] 施鑫[2] 周幸[2] 

机构地区：[1]南京大学医学院临床学院,江苏南京210002 [2]南京军区南京总医院骨科,江苏南京210002

出　　处：《实用骨科杂志》2017年第5期409-412,共4页Journal of Practical Orthopaedics

基　　金：国家自然基金项目(81472508);国家自然基金青年项目(81102039);江苏省自然科学基金项目(BK20141376);江苏省六大人才高峰项目(2014-WSW-042);2015年度军队医学科研计划(15QNP023);南京军区南京总医院课题(2014028)

摘　　要：目的探讨股骨近端病变的诊断、治疗及预后。方法对2001年1月至2014年12月在我院诊治的158例股骨近端病变进行回顾性分析。恶性肿瘤36例,良性病变122例。恶性肿瘤主要采取瘤段扩大切除髋关节假体置换术。良性病变的手术治疗主要采取病变刮除植骨内固定术,良性侵袭性肿瘤选择瘤段切除髋关节假体置换术。结果随访6~60个月,平均29个月,共19例失访。6例良性病变术后出现复发,恶性肿瘤中6例死亡,8例局部复发,6例出现肺转移。术后根据国际保肢学会(international society of limb salvage,ISOLS)功能评分,良性病变平均25.1分;恶性肿瘤平均19.7分。结论根据股骨近端病变的病理性质、病变范围选择个体化手术治疗,以减少局部病变复发,提高患者髋关节功能及改善预后。良恶性病变均可通过手术治疗获得满意的髋关节功能。Objective To investigate the diagnosis,treatment and prognosis of lesions in proximal femoral.Methods 158 patients with proximal femoral lesions in our hospital fromJanuary 2001 to December 2014 were analyzed retrospectively.36 cases was diagnosed malignant tumors,and 122 cases was diagnosedbenign lesions.Malignant tumor mainly adopted the extended resection of tumor sections with hip arthroplasty.The surgical treatment of benign lesions mainly took the lesions scraping in addition to graft bone with internal fixation.Aggressive benign tumors received tumor segment resection and prosthetic replacement of hip joint.Results Followed up for 6 to 60 months,with an average of 29 months,19 cases were lost.6 cases of benign lesions developed postoperative recurrence.6 cases of malignant tumorsdied,8 cases appeared local recurrence,6 cases developed pulmonary metastasis.According to ISOLS score,the average score of benign lesion was 25.1,and malignant tumors was 19.7.Conclusion In order to reduce local disease recurrence and improve the patient＇s hip function and improve prognosis,the surgical treatments should be based on the pathological characteristics and the scope of proximal femoral lesions.Whether benign lesions and malignant tumors,patients could acquiregood hip joint function by surgery.

关 键 词：股骨近端 骨肿瘤 骨巨细胞瘤 外科治疗 

分 类 号：R681.8[医药卫生—骨科学]