246例股骨近端良性骨肿瘤及瘤样病变手术治疗分析

发布时间：2018-02-12 22:32

  本文关键词： 股骨近端良性肿瘤 股骨近端瘤样病变 手术治疗 疗效分析 回顾性研究　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:股骨近端是儿童和成人良性骨肿瘤和肿瘤样病变最常见的部位之一,此部位解剖和功能上具有复杂性和特殊性,病理性骨折风险较高,因而通常采用手术治疗的方式。目的:回顾性分析股骨近端良性骨肿瘤和肿瘤样病变的手术治疗效果。方法:收集自2006年2月至2016年6月于我院行手术治疗的股骨近端病变患者246例。术前均行髋关节正位X线检查,205例行CT检查,197例行MRI检查。明确病变范围,无手术禁忌证,术中快速冰冻、术后病理学检查证实病变性质。结果:246例患者均经术后病理学证实,其中骨巨细胞瘤38例(合并病理性骨折2例),骨样骨瘤37例,骨纤维结构不良35例(合并病理性骨折3例),骨软骨瘤23例,骨囊肿22例(合并病理性骨折6例),嗜酸性肉芽肿14例,骨纤维异常增殖症12例,动脉瘤样骨囊肿11例(合并病理性骨折2例),骨巨细胞瘤合并动脉瘤样骨囊肿10例(合并病理性骨折1例),内生软骨瘤10例(合并病理性骨折2例),软骨母细胞瘤10例,韧带样纤维瘤5例,非骨化性纤维瘤4例(合并病理性骨折1例),血管瘤3例(合并病理性骨折1例),骨母细胞瘤3例,非骨化性纤维瘤合并动脉瘤样骨囊肿2例,骨膜软骨瘤2例,神经纤维瘤1例,骨纤维结构不良合并动脉瘤样骨囊肿1例(合并病理性骨折1例),软骨黏液样纤维瘤1例,骨母细胞瘤合并动脉瘤样骨囊肿1例,良性纤维组织细胞瘤1例。共19例合并病理性骨折,14例合并动脉瘤样骨囊肿。其中病变位于左股骨近端122例,右股骨近端124例。男151例,女95例,平均年龄28岁(2-72岁)。随访时间5-129个月,平均57个月。4例骨囊肿患者出现复发,其中1例发生2次复发和1次术后病理性骨折,1例外院治疗复发后于我院治疗,1例复发1次和术后病理性骨折1次,1例仅复发1次,均行刮除植骨内固定术。1例动脉瘤样骨囊肿患者外院刮除植骨治疗17个月后复发,于我院行刮除异体腓骨植骨术后3年再次出现局部复发,再次行病变刮除植骨术。1例骨巨细胞瘤患者病变复发,行刮除灭活植骨内固定翻修术。1例血管瘤患者复发后行病灶切除术。其余患者均未出现复发,随访结束时上述患者均未发现再复发,复发率为2.8%。Harris髋关节功能平均评分91分,优良率为93%。结论股骨近端良性骨病种类繁多,应根据股骨近端良性骨病类型及病变范围选择恰当的手术方式,可有效控制局部肿瘤复发,提高患者患肢功能和生活质量。
[Abstract]:Background: proximal femur is one of the most common sites of benign bone tumors and tumor-like lesions in children and adults. Objective: to retrospectively analyze the effect of surgical treatment of benign bone tumors and tumor-like lesions in proximal femur. Methods: from February 2006 to June 2016 in our hospital, we collected the surgical treatment of femur. Two hundred and twenty five patients with proximal bone lesions were examined by CT and MRI before operation. Results all 246 cases were confirmed by postoperative pathology, including 38 cases of giant cell tumor of bone (2 cases complicated with pathological fracture, 37 cases of osteoid osteoma, 2 cases of pathological fracture, 37 cases of osteoid osteoma). There were 35 cases of fibrous dysplasia (3 cases with pathological fracture, 23 cases with osteochondroma, 22 cases with bone cyst, 6 cases with pathological fracture, 14 cases with eosinophilic granuloma, 12 cases with fibrous dysplasia of bone). There were 11 cases of aneurysm like bone cyst (2 cases complicated with pathological fracture, 10 cases of giant cell aneurysm with aneurysm-like bone cyst, 1 case of pathological fracture, 10 cases of endophytic chondroma, 2 cases of complicated pathological fracture, 10 cases of chondroblastoma). There were 5 cases of desmoid fibroma, 4 cases of non-ossifying fibroma (1 case with pathological fracture, 3 cases of hemangioma, 1 case of pathological fracture, 3 cases of osteoblastoma, 2 cases of nonossifying fibroma with aneurysm-like bone cyst). There were 2 cases of periosteal chondroma, 1 case of neurofibroma, 1 case of fibrous dysplasia associated with aneurysm-like bone cyst (1 case with pathological fracture, 1 case of chondromyxoid fibroma, 1 case of osteoblastoma with aneurysm-like bone cyst). One case was benign fibrous histiocytoma. A total of 19 cases were complicated with pathological fracture and 14 cases with aneurysm-like bone cyst. Among them, 122 cases were located at the proximal end of the left femur, 124 cases were at the proximal end of the right femur, 151 cases were males and 95 cases were females. The mean age was 28 years old and 2-72 years old. The follow-up time was 5-129 months, and the mean time was 57 months. 4 cases of bone cysts recurred. Among them, 1 case had 2 recurrence and 1 postoperative pathological fracture. One case of recurrence occurred in our hospital after hospital treatment and only 1 case of 1 case of pathological fracture only recurred once after operation. All cases were treated with curettage and bone grafting and internal fixation. 1 cases of aneurysm like bone cysts recurred after 17 months of external curettage and bone grafting. Local recurrence occurred again 3 years after bone grafting of allogeneic fibula in our hospital. One case of giant cell tumor of bone recrudesced again, and 1 cases of hemangioma recurred by curettage and inactivation of bone graft. No recurrence was found in the rest of the patients. No recurrence was found at the end of follow-up. The recurrence rate was 2.8.Harris hip function score was 91, and the excellent and good rate was 93.Conclusion there are many kinds of benign bone diseases in proximal femur. According to the type and extent of benign bone disease of proximal femur, we should select the appropriate operative method, which can effectively control the recurrence of local tumor and improve the function and quality of life of the affected limb.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R738.1
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本文编号：1506715