儿童股骨近端良性骨病变伴病理性骨折的治疗及预后分析  

Treatments and outcomes of benign proximal femoral bone lesion with pathologic fracture in children.

作　　者：莫越强[1] 宋君[1] 王达辉[1] Mo Yueqiang;Song Jun;Wang Dahui(Department of Pediatric Orthopedics,Children's hospital of Fudan University,Shanghai,201102,China)

机构地区：[1]复旦大学附属儿科医院小儿骨科,上海市201102

出　　处：《临床小儿外科杂志》2020年第7期586-589,595,共5页Journal of Clinical Pediatric Surgery

基　　金：上海申康医院发展中心临床科技创新项目临床研究培育项目(编号:SHDC12019X28)。

摘　　要：目的探讨儿童股骨近端良性骨病变伴病理性骨折的治疗及预后。方法回顾性分析复旦大学附属儿科医院2011年6月至2018年6月收治的50例股骨近端良性骨病变患儿临床资料,14例同时伴有病理性骨折。14例中男童10例,女童4例;左侧8例,右侧6例;年龄5岁9个月至12岁11个月,平均7.5岁。病理检查结果显示:单纯性骨囊肿8例,骨纤维结构不良6例。根据患儿股骨近端肿瘤及骨折位置、累及范围、初步诊断选择不同的手术方案及内固定物。结果14例中1例手术后2个月失访,其余13例随访时间20~98个月,平均43.5个月。完全愈合4例,缺损愈合3例,病变持续存在5例,复发1例,总体愈合率53.8%。病理性骨折愈合时间6~31周,平均10.9周。术后1例出现骨骺早闭,大转子高位;1例出现髋关节活动受限;2例出现髋内翻畸形。无一例股骨头缺血性坏死或内固定失败。结论儿童股骨近端良性骨病变伴病理性骨折的治疗应综合考虑肿瘤类型、累及范围、骨折部位,制定个性化的治疗方案,才能获得满意的功能和影像学结果。Objective To explore the treatments and outcomes of benign proximal femoral bone disease with pathologic fracture in children.Methods Clinical data were retrospectively analyzed for 50 hospitalized children with benign proximal femoral bone lesions from June 2011 to June 2018.Pathologic fractures occurred in 14 children with an average age of 90(69-155)months.And there were 10 boys and 4 girls.The involved side was left(n=8)and right(n=6).The causes were simple bone cysts(n=8)and fibrous dysplasia(n=6).Surgical strategies and internal fixations were selected according to the location,range and initial diagnosis of proximal femoral tumor and fracture.Results One child was lost to follow-up at 2 months after surgery.The remainders were followed up for an average of 43.5(20-98)months.The outcomes were complete healing(n=4),defect healing(n=3),persistent existence(n=5)and recurrence(n=1).The healing rate was 53.8%.The healing time of pathological fracture had an average range of 10.9(6-31)weeks.There were a premature closure of epiphyses(n=1),a limitation of hip joint movement(n=1)and coxa vara(n=2).There was no avascular necrosis of femoral head or failure of internal fixation.Conclusion For children with benign proximal femoral bone lesions accompanied by pathological fracture,tumor type,range of involvement and fracture site should be considered comprehensively.Individualized treatments should be offered to obtain satisfactory functional and imaging outcomes.

关 键 词：股骨骨折 骨折 自发性 治疗结果 儿童 

分 类 号：R726.8[医药卫生—儿科] R683.42[医药卫生—临床医学]