摘要
[目的]介绍Watson-Jones入路保留骨膜开窗治疗股骨近端良性肿瘤的手术技术和初步临床结果。[方法] 2022年1月-2024年9月在本院Watson-Jones入路保留骨膜开窗治疗股骨近端良性肿瘤14例。采用全身麻醉或蛛网膜下腔麻醉,患者取仰卧位或半侧卧位。切口起始于髂前上棘外下方3~4 cm处,经股骨大粗隆,延伸至股骨外侧。向前方牵开阔筋膜张肌,向后方牵开臀中肌,将股外侧肌前方起点自大粗隆切断并向远处掀开,保留股骨近端前方骨膜的完整。根据病灶大小确定开窗范围,开窗部位位于股骨近端的前方。在预定的骨皮质开窗边缘的近端、远端、外侧锐性切开骨膜,随后通过皮质骨钻孔后用骨刀三面切开骨皮质,保留内侧骨膜的完整。在骨窗的内侧缘,经骨膜钻孔后用骨刀撬开开窗骨皮质,形成一个软组织铰链位于内侧并保留骨膜的皮质骨块。牵开骨块显露肿瘤并刮除肿瘤,如为活跃肿瘤,可用高速磨钻进一步磨除瘤腔内壁不规则骨皮质骨脊,或用电刀、蒸馏水等辅助手段灭活可能残留的肿瘤细胞。在完成肿瘤的刮除后,大量生理盐水冲洗切口。首先进行股骨近端的钢板或髓内钉内固定,然后瘤腔内植骨,确认植骨充分后将翻开的骨块复位,放置引流管,逐层闭合切口。[结果]所有患者均顺利完成手术,手术时间120~270 min,术中出血量30~1 000 mL。所有患者随访12~36个月,除1例发生了钢板断裂外,其他患者均病灶均顺利愈合,无并发症发生。与术前相比,末次随访时VAS评分[(3.1±1.8),(0.1±0.4), P<0.001]、Harris评分[(80.2±24.5),(98.9±2.2), P=0.014]均显著改善。[结论] Watson-Jones入路可安全、方便地显露股骨近端髓内良性肿瘤,具有损伤小、出血少的优点。保留骨膜的骨皮质开窗技术有利于开窗处的骨质愈合,提高疗效。
[Objective]To introduce the surgical technique and preliminary clinical outcome of periosteum preserved fenestration through Watson-Jones approach for curettage of benign tumors in the proximal femur.[Methods]From January 2022 to September 2024,14 patients received periosteum preserved fenestration through Watson-Jones approach for curettage of benign tumors in the proximal fe-mur.After general anesthesia or subarachnoid anesthesia,the patient was placed in the supine position or the semi-lateral position.The in-cision started approximately 3~4 cm below the outer side of the anterior superior iliac spine,passing the the femoral greater trochanter,and extended no the lateral side of the femur.Retracting tensor fascia forward and the gluteus medius backward,detach the vastus lateralis from the greater trochanter and reflect it distally with the periosteum intact.The fenestration range was determined according to the size of the le-sion,usually the site in front of the proximal femur.The periosteum was sharply incised at the proximal,distal and lateral borders of the pre-determined fenestration.After drilling through the cortical bone,the cortical fragment was cut on the three sides with an osteotome,while preserve the integrity of the medial periosteum flap.At the medial edge of the fenestration,the bone cortex was pried open after drilling through the periosteum to form a cortical bone flap with pedicle of the medial periosteum for exposure of the lesion.Curetting the lesion se-quentially,if it was an active tumor,a high-speed burr could be used to further grind off the irregular bone cortex and bone ridge on the in-ner wall of the tumor cavity,or other means,such as electrocautery and distilled water irrigation used to inactivate the possible remaining tu-mor cells.After the tumor was scraped off,the incision was rinsed with a large amount of normal saline.After that,internal fixation of the proximal femur with plate or intramedullary nail was performed,and then,bone grafts put into out in the tumor cavity.After confirming sufficient bone grafting,the opened bone fragment was reset,a drainage tube placed,and the incision closed in layers.[Results]All patients had the operation performed successfully with operation time of 120~270 min and intraoperative blood loss of 30~1000 mL.All patients were followed up for 12 to 36 months.Except one case where the plate fracture occurred,all patients had the lesions healed smoothly without any complications.Compared with those preoperatively,the VAS score[(3.1±1.8),(0.1±0.4),P<0.001]and Harris score[(80.2±24.5),(98.9±2.2),P=0.014]were significantly improved at the last follow-up.[Conclusion]The Watson-Jones approach can safely and conveniently expose benign intramedullary tumors in the proximal femur,with advantages of less injury and less bleeding.In addition,this cortical fenestration technique with periosteum preservation is conducive to bone healing at the fenestration site and improves the therapeutic consequence.
作者
刘阳
刘浩
张远鉴
崔路宽
葛文龙
周士猛
胡永成
LIU Yang;LIU Hao;ZHANG Yuan-jian;CUI Lu-kuan;GE Wen-long;ZHOU Shi-meng;HU Yong-cheng(Department of Bone and Soft Tissuc Oncology,Cangchou Hospital of Integrated Traditional Chinese and Western Medicine,Cangzhou 061000,Hebci,China;De-partment of Bone and Sofi Tissue Oncology,Tianjün Hospital,Tanjün 300211,China)
出处
《中国矫形外科杂志》
北大核心
2025年第14期1326-1331,共6页
Orthopedic Journal of China
关键词
骨肿瘤
良性肿瘤
手术入路
股骨近端
bone tumor
benign tumor
surgical approach
proximal femur
