节段性切除一期骨重建治疗长骨纤维结构不良

One stage reconstruction of bone following segmental resection in the treatment of fibrous dysplasia of long bones

目的 探索治疗长骨纤维结构不良(FD)降低复发率的新途径。方法 从1988年7月至2001年8月采用节段性切除,一期骨重建治疗四肢FD27例29个骨。术式包括:(1)瘤段骨切除,离体切刮灭活再植,行自家骨或同种异体骨移植(ATBG,ALBG)。(2)全桡骨切除,自家腓骨置换(ATFI)1例。(3)同种异体腓骨置换(ALFR)3例4骨。除1例采用普通钢板外,28个骨均L-梯形钢板(L-TCP)固定,其中1例合并克氏针固定。另一侧单一克氏针固定。平均骨缺损12.3cm(7.8～23.5cm)。结果 22例23个骨随访1年至13年8个月,2例切口感染,均于术后l～2年治愈。全部截骨处均愈合,仅1例股骨上端FD并发髋内翻。2例复发,为酒精灭活再植病例。17例18个肢体的关节功能优,良好、尚可各2例,1例差。结论瘤体骨节段性切除,一期骨重建的术式不仅可以有效地降低复发率,而且有利于骨愈合和恢复功能,减少井发症。

Objective To search new procedures for reducing the recurrence rate of fibrous dysplasia (FD) of long bones. Materials and Methods Segmental resection of FD and reconstruction of bone at one stage were performed on 27 patients with 29 bones from July 1988 to August 2001. The procedures of bone reconstruction included 1. Tumor bone was resected and replanted to its position after curettage and devitalization by soaking in 95 % or 75 % alcohol for 30minutes and then grafted with autogenous or allogenous bone graft (ATBG, ALBG). There were 24 bones of 23cases that underwent this procedure In this series 21 autogenous and 3 allogenous fibulae were used for intramedullary graftiong (AL, FIG, ALFIG) 2. Autogenous fibula replacement (ATFR) was perfrmed in 1 patient with FD of whole radius 3. Allogenous fibula replacement (ALFR), which fibulae were obtained from their parents was performed in 4 bones of 3 young cases. The osteotomies of all bones but one were fixed by L-trapezoid compression plate (L-TCP) and 2 of them had to combine with Kirschner pin stabilization. The average length of bone defect was 12. 3cm (ranged 7. 8cm - 13.5cm.). Results Twenty three bones of 22 patients were followed - up from 1 year to 13 years and 8 months Wound infection occurred in 2 cases, which treated with ALBG and were cured 1 and 2 years after surgery. Osteotomies had sound union but one associated with coax varus. Recurrance developed in 2 cases treated by alcohol devitalization and re- plantation (9.1% ). Functions of 18 limbs of 17 patients were rated excellent 2 good, 2 fair and 1 poor. Conclusions Segmental resection and reconstruction with replantation of tumor bone after devitalization and L-TCP fixation are indi- cated for tratment of most fd of long bones It is not only effective for decreasing recurrence but also beneficial for bone healing and functional recovery with less complications