• 瀘州醫(yī)學院附屬醫(yī)院骨與關節(jié)外科（四川瀘州，646000）;

目的探討病灶清除植骨結合彈性髓內釘內固定術治療兒童肱骨良性病變并病理性骨折的療效及特點。 方法2007年1月－2011年1月采用病灶清除植骨結合彈性髓內釘內固定術治療兒童肱骨良性病變并病理性骨折11例。其中男7例，女4例；年齡5～14歲，平均9.4歲。病程2～14 d，平均6 d。均為閉合性骨折。單純骨囊腫7 例，纖維結構不良3例，動脈瘤樣骨囊腫1例。肱骨近端6例，肱骨干4例，肱骨遠端1例。根據影像學檢查，術前診斷基本明確。入院至手術時間3～5 d。 結果術后切口均Ⅰ期愈合，未出現深部組織感染等并發(fā)癥。11例均獲隨訪，隨訪時間12～36個月，平均25.6個月。疼痛于術后6周完全消失。X線片示患兒骨折均達骨性愈合，愈合時間3～4個月，平均3.3個月。隨訪期間未出現病變復發(fā)或再骨折。術后10～14個月，平均12.5個月取出彈性髓內釘。末次隨訪時病灶完全消失（8例）或部分消失（3例）；患肢無疼痛，肩、肘關節(jié)活動均不受限。1例患肢較健側短縮約2 cm，但患肢功能及活動無影響。根據Neer肩關節(jié)和Mayo肘關節(jié)功能評分標準，11例患兒肩、肘關節(jié)功能均為優(yōu)。 結論病灶清除植骨結合彈性髓內釘內固定術可作為治療兒童肱骨良性病變并病理性骨折的較理想方法，僅需單次手術干預，愈合較快、穩(wěn)定性高，允許患兒早期康復鍛煉，肩、肘關節(jié)功能恢復良好。

引用本文： 羅雷茗,魯曉波,葛建華,葉里子,王遠輝. 彈性髓內釘內固定術治療兒童肱骨良性病變并病理性骨折. 中國修復重建外科雜志, 2013, 27(1): 21-24. doi: 復制

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1. Grzegorzewski A, Pogonowicz E, Sibinski M, et al. Treatment of benign lesions of humerus with resection and non-vascularised, autologous fibular graft. Int Orthop, 2010, 34(8): 1267-1272.
2. Ba?arir K, Pi?kin A, Güçlü B, et al. Aneurysmal bone cyst recurrence in children: a review of 56 patients. J Pediatr Orthop, 2007, 27(8): 938-943.
3. Kanellopoulos AD, Mavrogenis AF, Papagelopoulos PJ, et al. Elastic intramedullary nailing and DBM-bone marrow injection for the treatment of simple bone cysts. World J Surg Oncol, 2007, 5: 111.
4. 張世民, 李海豐, 黃軼剛. 骨折分類與功能評定. 北京: 人民軍醫(yī)出版社, 2008: 304-318.
5. Saraph V, Linhart WE. Modern treatment of pathological fractures in children. Injury, 2005, 36 Suppl 1: A64-74.
6. Neer CS 2nd, Francis KC, Marcove RC, et al. Treatment of unicameral bone cyst. A follow-up study of one hundred seventy-five cases. J Bone Joint Surg (Am), 1966, 48(4): 731-745.
7. Mik G, Arkader A, Manteghi A, et al. Results of a minimally invasive technique for treatment of unicameral bone cysts. Clin Orthop Relat Res, 2009, 467(11): 2949-2954.
8. Capanna R, Campanacci DA, Manfrini M. Unicameral and aneurysmal bone cysts. Orthop Clin North Am, 1996, 27(3): 605-614.
9. Docquier PL, Delloye C. Treatment of aneurysmal bone cysts by introduction of demineralized bone and autogenous bone marrow. J Bone Joint Surg (Am), 2005, 87(10): 2253-2258.
10. Sung AD, Anderson ME, Zurakowski D, et al. Unicameral bone cyst: a retrospective study of three surgical treatments. Clin Orthop Relat Res, 2008, 466(10): 2519-2526.
11. Knorr P, Schmittenbecher PP, Dietz HG, et al. Elastic stable intramedullary nailing for the treatment of complicated juvenile bone cysts of the humerus. Eur J Pediatr Surg, 2003, 13(1): 44-49.
12. DiCaprio MR, Enneking WF. Fibrous dysplasia. Pathophysiology, evaluation, and treatment. J Bone Joint Surg (Am), 2005, 87(8): 1848-1054.
13. Enneking WF, Gearen PF. Fibrous dysplasia of the femoral neck. Treatment by cortical bone-grafting. J Bone Joint Surg (Am), 1986, 68(9): 1415-1422.
14. Shih HN, Su JY, Hsu KY, et al. Allogeneic cortical strut for benign lesions of the humerus in adolescents. J Pediatr Orthop, 1997, 17(4): 433-436.
15. Tsuchiya H, Morsy AF, Matsubara H, et al. Treatment of benign bone tumours using external fixation. J Bone Joint Surg (Br), 2007, 89(8): 1077-1083.
16. Rapp M, Svoboda D, Wessel LM, et al. Elastic Stable Intramedullary Nailing (ESIN), Orthoss? and Gravitational Platelet Separation—System (GPS?): an effective method of treatment for pathologic fractures of bone cysts in children. BMC Musculoskelet Disord, 2011, 12: 45.
17. Atesok K, Liebergall M, Sucher E, et al. Treatment of pathological humeral shaft fractures with unreamed humeral nail. Ann Surg Oncol, 2007, 14(4): 1493-1498.
18. Ward EF, White JL. Interlocked intramedullary nailing of the humerus. Orthopedics, 1989, 12(1): 135-141.
19. Pogoreli? Z, Furlan D, Bioci? M, et al. Titanium intramedullary nailing for treatment of simple bone cysts of the long bones in children. Scott Med J, 2010, 55(3): 35-38.
20. Kokavec M, Fristakova M, Polan P, et al. Surgical options for the treatment of simple bone cyst in children and adolescents. Isr Med Assoc J, 2010, 12(2): 87-90.
21. 蔣欣, 陳小亮, 王道喜, 等. 兒童四肢長骨病理性骨折手術治療60例. 臨床小兒外科雜志, 2011, 10(5): 337-340.
22. Finkemeier CG. Bone-grafting and bone-graft substitutes. J Bone Joint Surg (Am), 2002, 84-A(3): 454-464.
23. Dimitriou R, Jones E, McGonagle D, et al. Bone regeneration: current concepts and future directions. BMC Med, 2011, 9: 66.
24. Hagmann S, Eichhorn F, Moradi B, et al. Mid- and long-term clinical results of surgical therapy in unicameral bone cysts. BMC Musculoskeletal Disorders, 2011, 12: 281.
  1. 1. Grzegorzewski A, Pogonowicz E, Sibinski M, et al. Treatment of benign lesions of humerus with resection and non-vascularised, autologous fibular graft. Int Orthop, 2010, 34(8): 1267-1272.
  2. 2. Ba?arir K, Pi?kin A, Güçlü B, et al. Aneurysmal bone cyst recurrence in children: a review of 56 patients. J Pediatr Orthop, 2007, 27(8): 938-943.
  3. 3. Kanellopoulos AD, Mavrogenis AF, Papagelopoulos PJ, et al. Elastic intramedullary nailing and DBM-bone marrow injection for the treatment of simple bone cysts. World J Surg Oncol, 2007, 5: 111.
  4. 4. 張世民, 李海豐, 黃軼剛. 骨折分類與功能評定. 北京: 人民軍醫(yī)出版社, 2008: 304-318.
  5. 5. Saraph V, Linhart WE. Modern treatment of pathological fractures in children. Injury, 2005, 36 Suppl 1: A64-74.
  6. 6. Neer CS 2nd, Francis KC, Marcove RC, et al. Treatment of unicameral bone cyst. A follow-up study of one hundred seventy-five cases. J Bone Joint Surg (Am), 1966, 48(4): 731-745.
  7. 7. Mik G, Arkader A, Manteghi A, et al. Results of a minimally invasive technique for treatment of unicameral bone cysts. Clin Orthop Relat Res, 2009, 467(11): 2949-2954.
  8. 8. Capanna R, Campanacci DA, Manfrini M. Unicameral and aneurysmal bone cysts. Orthop Clin North Am, 1996, 27(3): 605-614.
  9. 9. Docquier PL, Delloye C. Treatment of aneurysmal bone cysts by introduction of demineralized bone and autogenous bone marrow. J Bone Joint Surg (Am), 2005, 87(10): 2253-2258.
  10. 10. Sung AD, Anderson ME, Zurakowski D, et al. Unicameral bone cyst: a retrospective study of three surgical treatments. Clin Orthop Relat Res, 2008, 466(10): 2519-2526.
  11. 11. Knorr P, Schmittenbecher PP, Dietz HG, et al. Elastic stable intramedullary nailing for the treatment of complicated juvenile bone cysts of the humerus. Eur J Pediatr Surg, 2003, 13(1): 44-49.
  12. 12. DiCaprio MR, Enneking WF. Fibrous dysplasia. Pathophysiology, evaluation, and treatment. J Bone Joint Surg (Am), 2005, 87(8): 1848-1054.
  13. 13. Enneking WF, Gearen PF. Fibrous dysplasia of the femoral neck. Treatment by cortical bone-grafting. J Bone Joint Surg (Am), 1986, 68(9): 1415-1422.
  14. 14. Shih HN, Su JY, Hsu KY, et al. Allogeneic cortical strut for benign lesions of the humerus in adolescents. J Pediatr Orthop, 1997, 17(4): 433-436.
  15. 15. Tsuchiya H, Morsy AF, Matsubara H, et al. Treatment of benign bone tumours using external fixation. J Bone Joint Surg (Br), 2007, 89(8): 1077-1083.
  16. 16. Rapp M, Svoboda D, Wessel LM, et al. Elastic Stable Intramedullary Nailing (ESIN), Orthoss? and Gravitational Platelet Separation—System (GPS?): an effective method of treatment for pathologic fractures of bone cysts in children. BMC Musculoskelet Disord, 2011, 12: 45.
  17. 17. Atesok K, Liebergall M, Sucher E, et al. Treatment of pathological humeral shaft fractures with unreamed humeral nail. Ann Surg Oncol, 2007, 14(4): 1493-1498.
  18. 18. Ward EF, White JL. Interlocked intramedullary nailing of the humerus. Orthopedics, 1989, 12(1): 135-141.
  19. 19. Pogoreli? Z, Furlan D, Bioci? M, et al. Titanium intramedullary nailing for treatment of simple bone cysts of the long bones in children. Scott Med J, 2010, 55(3): 35-38.
  20. 20. Kokavec M, Fristakova M, Polan P, et al. Surgical options for the treatment of simple bone cyst in children and adolescents. Isr Med Assoc J, 2010, 12(2): 87-90.
  21. 21. 蔣欣, 陳小亮, 王道喜, 等. 兒童四肢長骨病理性骨折手術治療60例. 臨床小兒外科雜志, 2011, 10(5): 337-340.
  22. 22. Finkemeier CG. Bone-grafting and bone-graft substitutes. J Bone Joint Surg (Am), 2002, 84-A(3): 454-464.
  23. 23. Dimitriou R, Jones E, McGonagle D, et al. Bone regeneration: current concepts and future directions. BMC Med, 2011, 9: 66.
  24. 24. Hagmann S, Eichhorn F, Moradi B, et al. Mid- and long-term clinical results of surgical therapy in unicameral bone cysts. BMC Musculoskeletal Disorders, 2011, 12: 281.