• 瀘州醫(yī)學(xué)院附屬醫(yī)院骨與關(guān)節(jié)外科（四川瀘州，646000）;

目的探討病灶清除植骨結(jié)合彈性髓內(nèi)釘內(nèi)固定術(shù)治療兒童肱骨良性病變并病理性骨折的療效及特點(diǎn)。 方法2007年1月－2011年1月采用病灶清除植骨結(jié)合彈性髓內(nèi)釘內(nèi)固定術(shù)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(jié)構(gòu)不良3例，動(dòng)脈瘤樣骨囊腫1例。肱骨近端6例，肱骨干4例，肱骨遠(yuǎn)端1例。根據(jù)影像學(xué)檢查，術(shù)前診斷基本明確。入院至手術(shù)時(shí)間3～5 d。 結(jié)果術(shù)后切口均Ⅰ期愈合，未出現(xiàn)深部組織感染等并發(fā)癥。11例均獲隨訪，隨訪時(shí)間12～36個(gè)月，平均25.6個(gè)月。疼痛于術(shù)后6周完全消失。X線片示患兒骨折均達(dá)骨性愈合，愈合時(shí)間3～4個(gè)月，平均3.3個(gè)月。隨訪期間未出現(xiàn)病變復(fù)發(fā)或再骨折。術(shù)后10～14個(gè)月，平均12.5個(gè)月取出彈性髓內(nèi)釘。末次隨訪時(shí)病灶完全消失（8例）或部分消失（3例）；患肢無(wú)疼痛，肩、肘關(guān)節(jié)活動(dòng)均不受限。1例患肢較健側(cè)短縮約2 cm，但患肢功能及活動(dòng)無(wú)影響。根據(jù)Neer肩關(guān)節(jié)和Mayo肘關(guān)節(jié)功能評(píng)分標(biāo)準(zhǔn)，11例患兒肩、肘關(guān)節(jié)功能均為優(yōu)。 結(jié)論病灶清除植骨結(jié)合彈性髓內(nèi)釘內(nèi)固定術(shù)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(shù)干預(yù)，愈合較快、穩(wěn)定性高，允許患兒早期康復(fù)鍛煉，肩、肘關(guān)節(jié)功能恢復(fù)良好。

引用本文： 羅雷茗,魯曉波,葛建華,葉里子,王遠(yuǎn)輝. 彈性髓內(nèi)釘內(nèi)固定術(shù)治療兒童肱骨良性病變并病理性骨折. 中國(guó)修復(fù)重建外科雜志, 2013, 27(1): 21-24. doi: 復(fù)制

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(píng)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(zhǎng)骨病理性骨折手術(shù)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(píng)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(zhǎng)骨病理性骨折手術(shù)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.