Reparation And Reconstruction Of Defect Of Tumor And Tumor-like Lesion In Proximal Femur

Objective To discuss the effective reconstruction of defect of tumor and tumor-like lesion in proximal femurMethod To make a retrospective analysis of surgical treatment and operation results of 56 patients with bone tumor or tumor-like lesion in proximal femur between 2000 and 2005. There were 26 males and 30 females with 13～62years old(mean 27.23 yrs). They are 11 cases of fibrous dysplasia, 4 cases of aneurysmal bone cyst, 4 cases of bone cyst, 1 case of nonossifying fibroma, 2 cases of enchondroma, 2 cases of osteoid osteoma, 8 cases of giant cell tumor, 7 cases of chondrosarcoma, 9 cases of osteosarcoma, 2 cases of Ewing sarcoma, 1 case of malignant fibrous histiocytoma and 5 cases of metastatic tumor. Surgery of curettage, bone grafting was performed in 17 cases which were limited benign tumors and tumor-like lesions, surgery of curettage, bone grafting and internal fixation with DHS or PFN in 13 cases which has been with pathologic fracture or in danger of pathologic fracture, en-bloc resection of tumor and reconstruction of joint with custom-made prosthesis was performed in 2 cases of giant cell tumor and 19 cases of malignant tumors, 5 cases of metastatic tumor was with PMMN and nail or custom-made prosthesis. Rehabilitation plan was made after surgery, according to X-ray inspection and fracture healing conditions. The cases of only bone grafting should load walk at least four weeks after reconstruction; cases of bone graftng and internal fixation should gradually load at least six weeks after reconstruction; cases of prosthesis should be required to rebuild muscle strength and physical training for at least six months. 56 cases was reviewed with outpatient follow-up, letters or telephone follow-up.Results Wound effusion occurred in one case in 3 days after operation. During the follow-up time(6months-51 months), X-ray film of postoperation showed bone union in defect in cases of bone grafting . Local relapse occurred in 3 cases, one of them had relapse with proximal femur fracture near the plate , and healed after resurgery. The functional results were good in other cases , who could walk without external supports in 4-12 months after operation.There were one death of lung metastasis and one prosthesis fracture in cases of prosthesis, The score of Enneking functional evaluation of limb salvage was 80.0%-93.3%, and the score of metastasis was 78.8%.Conclusion According to the tumorous biological behavior and the proximal femur biological mechanics, a effective reconstruction could be made for the defect of tumor and tumor-like lesion in proximal femur.