原发性股骨近端溶骨性骨缺失修复重建.docVIP

原发性股骨近端溶骨性骨缺失修复重建 　 作者：杜远义 王光勇 敦先礼 周宏斌 李久鸿 【摘要】 目的 总结和分析股骨近端原发性溶骨性骨缺损的手术修复方法。 方法 自1997～2003年我科共收治股骨近端原发性溶骨性骨缺损36例。根据肿瘤的性质及大小分别采用病灶刮除+自体（异体）皮松质骨植入8例;病灶刮除+自体（异体）皮松质骨+自体缝匠肌髂骨瓣复合植入+内固定术22例;病灶刮除+骨水泥填充+内固定5例;瘤段切除+人工双动股骨头置换1例。 结果 术后随访12～54个月，平均24个月，仅1例骨巨细胞瘤复发，关节功能评分33例优，3例良。 结论 根据肿瘤的性质和股骨近端骨缺损大小采取不同手术方式进行了病灶清除及功能重建，是一套有效的重建股骨近端骨缺损的方案。 　　关键词 股骨近端 骨肿瘤 骨移植 内固定术 骨水泥 　　Repair and reconstruction of primary osteolytic defect in the proximal femur 　　【Abstract】 Objective To analyze and make a conclusion on the operative repair method of primary osteolytic defect in the proximal femur.Methods 36cases of primary osteolytic defect of proximal femoral were treated from1997to2003with curettage and corticocancellous autograft（allograft）implanted，22cases were treated with curettage and combination with corticocancellous autograft（allograft）and implantation of autologous sartorius muscular iliac flap and internal fixation，5cases were treated with curettage and the load of bone cement，1case was treated with en bloc resection and replacement of bipolar prosthesis according to the type and range.Results At mean follow-up24（rang12～54）months，there was only one giant cell neoplasm of bone recurrence in all patients，and the functional results were excellent in thirty-three cases and good in three cases.Conclusion This surgical plan is a practical and effec-tive reconstruction plan for the bone defect of proximal femur.Through this plan，we could not only treat the tumor but also reconstruct the bone defect by different operative methods according to the type and the range of bone defect in the proximal femur. 　　Key words proximal femur bone tumor bone transplantation internal fixation bone cement 　　原发股骨近端溶骨性损害以瘤样病变和良性肿瘤居多。由于股骨近端的应力分布特点，肿瘤复发，病损合并骨折使外科治疗面临很多困难。我们不但要注意肿瘤本身的治疗，而且要修复因病灶清除后导致的股骨近端减弱的机械强度 ［1］ 。为了解其发病规律及治疗措施，将我院1997～2003年间收治的36例原发股骨近端溶骨性骨缺损修复重建进行总结。报告如下。 　　1 资料与方法 　　1.1 一般资料 1997～2003年我科共收治股骨头、股骨颈、转子间及转子下肿瘤样病变，良性肿瘤和低度恶性肿瘤36例。其中男24例，女12例。年龄8～47岁，平均29.5岁。左右侧无明显差异。病史为10天～1年。其中合并有