Treatment of benign bone lesions of proximal femur using dynamic hip screw and intralesional curettage via Watson-Jones approach_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIN Jiasheng ,  CHEN Rong , YAN Wei , ZHANG Yiyuan , CHEN Dongdong

Department of Musculoskeletal Tumor, the Second Hospital of Fuzhou Affiliated to Xiamen University, Fuzhou Fujian, 350007, P.R.China;

Corresponding author：

CHEN Rong, Email: doc-chen@163.com

Keywords：

Proximal femur; benign bone tumor; Watson-Jones approach; intralesional curettage; dynamic hip screw; internal fixation

DOI：

10.7507/1002-0179.201707092

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ObjectiveTo explore the effectiveness of dynamic hip screw (DHS) and intralesional curettage via Watson-Jones approach in treatment of benign bone lesions of the proximal femur.MethodsBetween March 2012 and December 2016, 20 patients (21 lesions) with benign bone tumors or tumor like conditions of proximal femurs were treated with DHS and intralesional curettage via Watson-Jones approach. Their average age was 27.8 years (range, 11-51 years), including 13 males and 7 females. The pathological diagnosis were fibrous dysplasia in 11 cases, simple bone cyst in 2 cases, aneurysmal bone cyst in 2 cases, benign fibrous histocytoma in 2 cases, giant cell tumor in 2 cases, and chondroblastoma in 1 case, including 3 pathological fractures. According to the Enneking staging system, 18 patients were in stage S1, 3 patients with pathological fractures in stage S2. There was no varus deformity or valgus deformity. The operation time, intraoperative blood loss, and time of full weight-bearing were recorded. X-ray film and CT were used to observe the bone graft fusion and location of DHS. Complications were recorded. Visual analogue scale (VAS) and Musculoskeletal Tumor Society (MSTS) scoring were used to evaluate function of lower limbs.ResultsThe average operation time was 177.1 minutes (range, 110-265 minutes). The average intraoperative blood loss was 828.6 mL (range, 200-2 300 mL). There was superficial incision infection in 1 case, deep incision infection in 1 case, and hip discomfort in 1 case, respectively. All patients were followed up 6-63 months (mean, 27.4 months). The time of full weight-bearing was 2 days in 2 patients with giant cell tumor and 2 to 13 weeks with an average of 7.2 weeks in the other patients. At last follow-up, VAS and MSTS were 0.19±0.51 and 29.62±0.97 respectively, showing significant differences when compared with the values before operation (3.52±2.62 and 23.71±8.77) (t=5.565, P=0.000; t=–3.020, P=0.007 ). X-ray film showed the all bone grafts fusion with mean time of 8.2 months (range, 5-12 months). There was no pathological fracture of the femur, local tumor recurrence, chronic hip pain, dislocation, or femoral head necrosis during follow-up.ConclusionThe treatment of benign bone lesion of the proximal femur using DHS and intralesional curettage via Watson-Jones approach is a safe and effective method.

Citation： LIN Jiasheng, CHEN Rong, YAN Wei, ZHANG Yiyuan, CHEN Dongdong. Treatment of benign bone lesions of proximal femur using dynamic hip screw and intralesional curettage via Watson-Jones approach. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(1): 31-35. doi: 10.7507/1002-0179.201707092 Copy

1.	Shih HN, Cheng CY, Chen YJ, et al. Treatment of the femoral neck and trochanteric benign lesions. Clin Orthop Relat Res, 1996, (328): 220-226.
2.	George B, Abudu A, Grimer RJ, et al. The treatment of benign lesions of the proximal femur with non-vascularised autologous fibular strut grafts. J Bone Joint Surg (Br), 2008, 90(5): 648-651.
3.	汤小东, 郭卫, 杨荣利, 等. 股骨近端良性肿瘤的外科治疗. 中国骨与关节外科, 2008, 1(2): 124-128.
4.	Bloem JL, Reidsma II. Bone and soft tissue tumors of hip and pelvis. Eur J Radiol, 2012, 81(12): 3793-3801.
5.	Nakamura T, Matsumine A, Asanuma K, et al. Treatment of the benign bone tumors including femoral neck lesion using compression hip screw and synthetic bone graft. SICOT J, 2015, 1: 15.
6.	Asavamongkolgul A, Thanakarasombat S. Treatment of bone tumors in the femoral trochanteric area. J Med Assoc Thai, 2012, 95 Suppl 9: S129-137.
7.	Shin SH, Yeo I, Seo SW. Can certain benign lesions of the proximal femur be treated without surgery? Clin Orthop Relat Res, 2013, 471(10): 3319-3325.
8.	Erol B, Topkar MO, Aydemir AN, et al. A treatment strategy for proximal femoral benign bone lesions in children and recommended surgical procedures: retrospective analysis of 62 patients. Arch Orthop Trauma Surg, 2016, 136(8): 1051-1061.
9.	田野, 陈龙刚, 史斌, 等. 病灶刮除植骨联合股骨近端解剖钢板在股骨近端良性肿瘤治疗中的应用. 中国骨伤, 2017, 30(2): 179-183.
10.	Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286): 241-246.
11.	Hu YC, Lun DX, Zhao SK. Combined anterior and lateral approaches for bone tumors of the femoral neck and head. Orthopedics, 2012, 35(5): e628-e634.
12.	Yu Y, Sun X, Song X, et al. A novel surgical approach for the treatment of tumors in the lesser trochanter. Experimental and Therapeutic Medicine, 2015, 10(1): 201-206.
13.	Gautier E, Ganz K, Krügel N, et al. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg (Br), 2000, 82(5): 679-683.
14.	罗殿中, 张洪. 一项基本的保髋手术技术: 髋关节外科脱位技术. 中华解剖与临床杂志, 2015, 20(5): 475-480.
15.	Mirels H. Metastatic disease in long bones: A proposed scoring system for diagnosing impending pathologic fractures.1989. Clin Orthop Relat Res, 2003, (415 Suppl): S4-13.
16.	Jaffe KA, Launer EP, Scholl BM. Use of a fibular allograft strut in the treatment of benign lesions of the proximal femur. Am J Orthop (Belle Mead NJ), 2002, 31(10): 575-578.
17.	Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev, 2010, (4): CD000093.
18.	Parker MJ, Handoll HH. Intramedullary nails for extracapsular hip fractures in adults. Cochrane Database of Systematic Reviews, 2014, (9): CD004961.

1. Shih HN, Cheng CY, Chen YJ, et al. Treatment of the femoral neck and trochanteric benign lesions. Clin Orthop Relat Res, 1996, (328): 220-226.
2. George B, Abudu A, Grimer RJ, et al. The treatment of benign lesions of the proximal femur with non-vascularised autologous fibular strut grafts. J Bone Joint Surg (Br), 2008, 90(5): 648-651.
3. 汤小东, 郭卫, 杨荣利, 等. 股骨近端良性肿瘤的外科治疗. 中国骨与关节外科, 2008, 1(2): 124-128.
4. Bloem JL, Reidsma II. Bone and soft tissue tumors of hip and pelvis. Eur J Radiol, 2012, 81(12): 3793-3801.
5. Nakamura T, Matsumine A, Asanuma K, et al. Treatment of the benign bone tumors including femoral neck lesion using compression hip screw and synthetic bone graft. SICOT J, 2015, 1: 15.
6. Asavamongkolgul A, Thanakarasombat S. Treatment of bone tumors in the femoral trochanteric area. J Med Assoc Thai, 2012, 95 Suppl 9: S129-137.
7. Shin SH, Yeo I, Seo SW. Can certain benign lesions of the proximal femur be treated without surgery? Clin Orthop Relat Res, 2013, 471(10): 3319-3325.
8. Erol B, Topkar MO, Aydemir AN, et al. A treatment strategy for proximal femoral benign bone lesions in children and recommended surgical procedures: retrospective analysis of 62 patients. Arch Orthop Trauma Surg, 2016, 136(8): 1051-1061.
9. 田野, 陈龙刚, 史斌, 等. 病灶刮除植骨联合股骨近端解剖钢板在股骨近端良性肿瘤治疗中的应用. 中国骨伤, 2017, 30(2): 179-183.
10. Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286): 241-246.
11. Hu YC, Lun DX, Zhao SK. Combined anterior and lateral approaches for bone tumors of the femoral neck and head. Orthopedics, 2012, 35(5): e628-e634.
12. Yu Y, Sun X, Song X, et al. A novel surgical approach for the treatment of tumors in the lesser trochanter. Experimental and Therapeutic Medicine, 2015, 10(1): 201-206.
13. Gautier E, Ganz K, Krügel N, et al. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg (Br), 2000, 82(5): 679-683.
14. 罗殿中, 张洪. 一项基本的保髋手术技术: 髋关节外科脱位技术. 中华解剖与临床杂志, 2015, 20(5): 475-480.
15. Mirels H. Metastatic disease in long bones: A proposed scoring system for diagnosing impending pathologic fractures.1989. Clin Orthop Relat Res, 2003, (415 Suppl): S4-13.
16. Jaffe KA, Launer EP, Scholl BM. Use of a fibular allograft strut in the treatment of benign lesions of the proximal femur. Am J Orthop (Belle Mead NJ), 2002, 31(10): 575-578.
17. Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev, 2010, (4): CD000093.
18. Parker MJ, Handoll HH. Intramedullary nails for extracapsular hip fractures in adults. Cochrane Database of Systematic Reviews, 2014, (9): CD004961.

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Treatment of benign bone lesions of proximal femur using dynamic hip screw and intralesional curettage via Watson-Jones approach

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