Analysis Of Surgical Treatment Of 246 Cases With Benign Bone Tumors And Tumor-like Lesions In Proximal Femoral

Background:The proximal femur is one of the most common locations for benign bone lesions in children and adults.This site is complex and specific with high risk of pathological fractures.Therefore,tumors located in the proximal femur are usually treated by surgery.Objective To retrospectively analyze the outcome of surgical treatment for benign proximal femoral lesions.Methods:A total of 246 patients with benign proximal femoral lesions were enrolled from February 2006 to June 2016 at our hospital.All patients underwent hip anteroposterior radiography before operation,205 cases underwent CT examination,and 197 cases underwent MRI examination.Range of lesions and no surgery contraindications were determined before operation.The final diagnosis of tumors was determined by intraoperative rapid freezing and postoperative general pathology.Results:246 patients were confirmed by general pathology,including 38 cases of giant cell tumor of bone(2 cases with pathological fracture),37 cases of osteoid osteoma,35 cases of bone fibrous dysplasia(3 cases with pathological fracture),23 cases of osteochondroma,22 cases of bone cyst(6 cases with pathological fracture),14 cases of eosinophilic granuloma,12 cases of bone fibrosis abnormalities,11 cases of aneurysmal bone cyst(2 cases with pathological fracture),10 cases of giant cell tumor of the bone with aneurysmal bone cysts(1 case with pathological fracture),10 cases of endogenous chondroma(2 cases with pathological fracture),10 cases of chondroblastoma,5 cases of ligamentous fibroma,4 cases of non-ossifying fibroma(1 case with pathological fracture),3 cases of hemangioma(1 case with pathological fracture),3 cases of osteoblastoma,2 cases of non-ossifying fibroma with aneurysmal bone cyst,2 cases of periosteal cartilage,1 case of neurofibroma,1 case of bone fibrous dysplasia with aneurysmal bone cyst(1 case with pathological fracture),1 case of cartilage mucinous fibroma,1 case of osteoblastoma with aneurysm bone cyst,1 case of benign fibrous cell tumor.A total of 19 patients had pathological fractures and 14 cases had aneurysmal bone cysts.The lesions of 122 cases were in the proximal left femur and 124 cases in the right proximal femur.There were 151 males and 95 females with an average age of 28 years(2-72 years).The average of follow-up time was 57 months(5-129 months).There were 4 recurrent bone cyst patients,including 1 case with 2 recurrence and 1 postoperative pathological fracture,1 with recurrence after surgical treatment in other hospital,1 case with 1 recurrence and 1 postoperative pathological fracture,1 case with only 1 recurrence.All of these patients were treated by curettage with bone graft and internal fixation.1 aneurysmal bone cyst patient treated by curettage with bone graft in other hospital had recurrence after 17 months and then was treated by curettage with allogeneic fibula graft.Unfortunately,the local recurrence was found again after 3 years,and curettage with bone graft was performed again.1 case of giant cell tumor of bone had recurrence and was revised by curettage with bone graft and internal fixation.One patient with hemangioma had recurrence and was treated by resection.No recurrence was found in the remaining patients at the end of follow-up and the recurrence rate was 2.8%.Mean Harris hip function score was 91 points,and the excellent rate was 93%.Conclusion:There are many kinds of benign bone diseases in the proximal femur.The appropriate surgical approach should be selected according to the type and range of benign proximal femoral bone lesions,which can effectively control the local recurrence of tumors and improve function of the limbs and quality of life.