目的 探讨股骨头软骨母细胞瘤的诊断及治疗方法.方法 对1999年2月至2008年3月收治的13例股骨头软骨母细胞瘤病例的诊断和治疗进行回顾性分析,男8例,女5例;年龄9～29岁,平均17.9岁.术前Hartis评分平均为67分(38～78分).所有患者术前经详细的影像学评估后行手术治疗.术前活检3例,术中冰冻病理检查2例.所有最终诊断以术后病理为准.所有患者行前侧Smith-Peterson入路经股骨头圆韧带止点开窗行肿瘤刮除植骨术,自体骨植骨7例,异体骨植骨5例,自体骨加异体骨混合植骨1例.结果 13例均获得随访,中位随访时间26个月(6～84个月).所有患者随访期间无肿瘤复发.1例自体骨植骨患者术后2个月部分负重后出现股骨头塌陷坏死,6个月后改行股骨头切除人工全髋关节置换.其余患者功能良好,术后Harris评分平均88分(69～98分),较术前提高21分.自体骨植骨患者平均骨愈合时间5.3个月(3～11个月),异体骨植骨患者6.8个月(3～13个月),混合植骨患者4个月.结论 股骨头软骨母细胞瘤是一种少见肿瘤,有独特的临床及影像学特征.髋关节前侧Smith-Peterson入路经股骨头圆韧带止点开窗肿瘤刮除植骨术是一种有效的治疗方案.术后植骨愈合前避免负重,并进行免负重髋关节功能锻炼,可以提高治疗效果.%Objective To investigate the diagnostic and therapeutic methods of chondroblastoma of the femoral head. Methods The thirteen consecutive patients with chondroblastomas of the femoral head were evaluated between February 1999 and March 2008 retrospectively. There were eight males and 5 females. The mean age was 17.9 years (range, 9-29 years).The mean Harris Score before surgery was 67 (range, 38-78). All patients were evaluated by detailed imaging studies before surgery. Biopsy was performed in three patients. Frozen section histology during surgery was performed in another two patients. All the diagnoses were confirmed by pathological examination. All the patients underwent surgery through Smith-Peterson approach. During the operatin, The tumor tissue was thoroughly curetted via fovea of femoral head. Bone grafting was performed in all patients, including autogenous bone grafts in 7 cases , allografts in 5 cases and the mixture of autogenous and allografts in 1 case. Results All the patients were followed up. The median time was 26 months (range, 6-84 months). There was no local recurrence in this group .No operative complications were found during follow-up. One patient who underwent autogenous bone graft had suffered femoral head necrosis after partial weight bearing 2 months after operation.The further intervention included femoral head resection and total hip arthroplasty 6 months after operation in this patient. The remaining patients presented with good function. The mean Harris Score was 89 (range, 69-98 ) after surgery, 21 points increasing from preoperative scores. The mean healing time was 5.3 months, 6.8 months, and 4 months in patents received autogenous bone grafts, allografts and the mixture of autogenous and allografts, respectvely. Conclusion Chondroblastoma of the femoral head, which is uncommon has its specific clinical and radiological characteristics. The curettage can been carried out via fovea of femoral head followed by bone grafting through anterior Smith-Peterson approach. This procedure proved to be a useful surgical approach for the treatment of chodroblastoma in the epiphysis of the femoral head. Weight bearing must be avoided before bone healing. Hip joint exercise without weight bearing can improve the outcome.
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