CAJ | 학술논문

目的探讨前外侧和外侧联合入路肿瘤刮除植骨重建治疗股骨颈骨肿瘤的疗效.方法 2005年7月至2009年8月采用前外侧和外侧联合入路手术治疗股骨颈肿瘤12例,男7例,女5例;年龄1768岁,平均34岁.软骨母细胞瘤4例,原发性骨巨细胞瘤2例,纤维结构不良3例,骨囊肿3例.7例有病理性骨折,5例骨皮质变薄.按国际保肢协会股骨颈肿瘤分区H1区1例、H2区4例、H1,2区7例.前外侧Smith-Peterson入路行肿瘤刮除植骨,外侧Watson-Jones入路行内固定.内固定采用解剖钢板10例,经皮空心螺钉2例.结果全部患者随访12～68个月,平均35个月.患者疼痛均消失,随访期间无复发,无病理性骨折、股骨头坏死、关节退变.1例出现股骨外侧皮肤麻木,术后6个月自行缓解;1例出现外展无力.11例恢复正常活动范围,前屈120°～135°,后伸9°～15°,外展30°～45°.国际骨与软组织肿瘤协会功能评分27～30分,平均29.2分.结论前外侧"SP"入路可以充分暴露肿瘤部位,手术视野清晰,刮除彻底,复发率低;外侧"WJ"入路易于植入内固定,防止术后病理性骨折的发生.股骨颈骨折采用前外侧"SP"与外侧"WJ"联合入路肿瘤刮除植骨重建的近期疗效较好.
목적 탐토전외측화외측연합입로종류괄제식골중건치료고골경골종류적료효.방법 2005년7월지2009년8월채용전외측화외측연합입로수술치료고골경종류12례,남7례,녀5례;년령1768세,평균34세.연골모세포류4례,원발성골거세포류2례,섬유결구불량3례,골낭종3례.7례유병이성골절,5례골피질변박.안국제보지협회고골경종류분구H1구1례、H2구4례、H1,2구7례.전외측Smith-Peterson입로행종류괄제식골,외측Watson-Jones입로행내고정.내고정채용해부강판10례,경피공심라정2례.결과 전부환자수방12～68개월,평균35개월.환자동통균소실,수방기간무복발,무병이성골절、고골두배사、관절퇴변.1례출현고골외측피부마목,술후6개월자행완해;1례출현외전무력.11례회복정상활동범위,전굴120°～135°,후신9°～15°,외전30°～45°.국제골여연조직종류협회공능평분27～30분,평균29.2분.결론 전외측"SP"입로가이충분폭로종류부위,수술시야청석,괄제철저,복발솔저;외측"WJ"입로역우식입내고정,방지술후병이성골절적발생.고골경골절채용전외측"SP"여외측"WJ"연합입로종류괄제식골중건적근기료효교호.
Objective To explore surgical procedure of combined anterior-lateral and lateral approach for the treatment of bone tumors of femoral neck. Methods Forty patients with bone tumors of femoral neck treated in Tianjin Hospital were included from July 2005 to August 2009. Of the patients, 12 who were treated with curettage and bone graft through combined anterior-lateral and lateral incision were analyzed in this study. There were 7 males and 5 females with an average age of 34 years ranging from 17 to 68 years. 4 patients were diagnosed as chondroblastoma, 2 giant cell tumor, 3 fibrous dysplasia, and 3 single bone cysts. 7 patients suffered from pathologic fractures, and 5 had presented thin cortical bone because of tumor involvement. There were 1 tumor located in H1 zone, 4 in H2 zone and 7 in H1,2 zone according to ISOLS femoral neck classification. All patients were treated by curettage and bone graft via anterior-lateral approach, 10 cases underwent internal fixation with anatomical plate, and 2 cases with canulated screws with lateral approach. Results The follow-up time ranged from 10 to 68 months with an average of 35 months.Pain disappeared in all patients, and there were not recurrence of tumor, pathologic fractures and avascular necrosis. One case had complained of lateral femoral skin numbness which may be caused by injures of femoral lateral nerves. One case had difficulties in the valgus of hip joint. The mean MSTS score was 29.2 points ranging from 27 to 30 points. Conclusion Anterior approaches of "SP" incision is helpful to thorough curettage which decrease the risk of recurrence due to good visualization and intemal fixation is easy to perform via lateral approaches. The result suggested that combined anterior-lateral "SP" and lateral incision is liable option in treatment of bone tumors of femoral neck.