curettage and bone grafting

Children's bone tumors include primary and secondary bone tumors. Primary bone tumors refer to benign bone tumors, malignant bone tumors and tumor-like lesions originating from bone tissue. Secondary bone tumors refer to other organ malignant tumors. A tumor of bone tissue. Clinically, benign bone tumors and tumor-like lesions are more common. Among malignant bone tumors, osteosarcoma is the most common. In recent years, due to the advancement of surgical techniques, the establishment of surgical system of bone tumor surgery and the extensive application of adjuvant chemotherapy before and after surgery have significantly improved the surgical treatment of bone tumors. The 2-year tumor-free survival rate has increased from 30% to 80%. Moreover, amputation is no longer the first choice for the treatment of malignant bone tumors. Many scholars advocate the use of local extensive or local radical bone tumor resection and limb preservation surgery, that is, surgical removal of tumor lesions, and the use of adjuvant chemotherapy to eliminate the occurrence of Microscopic metastatic lesions. Treatment of diseases: bone tumors Indication Scraping and bone grafting are suitable for single bone cysts, aneurysmal bone cysts, non-ossifying fibroids, and poor fibrous structures. Contraindications 1. Malignant bone tumors and invasive benign bone tumors such as osteoblastoma. 2. The nature of the bone tumor is unknown. Preoperative preparation 1. Clinical examination and X-ray film can not exclude malignant tumors should first do biopsy. 2. Prepare allogeneic bone or determine the site where the autologous bone is removed. Surgical procedure Incision Make an arc-shaped incision on the inside of the shoulder, marked by the condyle, extending outward to the acromioclavicular joint, and then down the deltoid leading edge to the lower third of the muscle. Cut the skin and deep fascia, and properly distract and retract the flap to both sides. Pay attention to the cephalic vein where the deltoid and pectoralis major muscles are combined. The deltoid muscle is then cut along the direction of the muscle fibers 0.5 cm outside the leading edge of the deltoid muscle, and a narrow strip of deltoid muscle fibers is attached to the cephalic vein to avoid damage to the cephalic vein when the deltoid muscle is separated. 2. Reveal the metaphysis of the humerus The deltoid muscle is bluntly separated and pulled to the outside, and the deltoid fiber strip, the cephalic vein and the pectoralis major muscle are pulled to the medial side to reveal the metaphysis of the humerus and the long head of the biceps brachii. At 1 cm outside the long head of the biceps muscle, the periosteum of the tibia was cut longitudinally. 3. Open the window and enter the lesion After the periosteum is dissected, subperiosteal dissection is performed along the direction of the flap. An oval round window marking line is first designed on the surface of the cortical bone of the tumor area, and then the drilling line is continuously drilled along the marking line, and then the bone marrow is cut along the bone hole and the free cortical bone is picked up to reveal the medullary cavity lesion. If it is a simple bone cyst, yellow liquid can be seen. If the lesion is not adequately exposed, use a rongeur to remove the cortical bone at the edge of the bone window. 4. Scraping lesions Firstly, the fibrous tissue of the capsule wall is scraped off with a curette and left as a pathological specimen, and then the narrowed curved bone knife is used to remove the hardened osteophytes and the reactive hardened bone tissue in the cyst cavity, so as to be thorough. 5. Bone graft and suture incision After flushing the bone cavity with saline, fill the gauze to temporarily stop bleeding. Sometimes a bipolar electrocautery can be used to burn the wall of the capsule to more completely destroy the wall tissue. The allogeneic bone or autologous bone is then cut into thin strips to fill the bone cavity, and the bone graft strips are brought into close contact with each other. The final layer is sutured to close the skin incision. A rubber drain strip is placed inside the slit. complication Pathological fracture There are two main reasons for pathological fractures. One is the swelling and growth of bone cysts, which makes the cortical bone thinner into a shell shape, which can be fractured with a little external force. Another reason is that the operation window is too large or the operation is not gentle enough. . Once it occurs, it should be treated as a fracture.

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