股骨纤维结构不良伴重度内翻畸形的外科治疗

Surgical treatment of fibrous dysplasia of bone involving the femur with severe varus deformity

[目的]探索一种治疗股骨纤维结构不良伴重度髋或及股内翻畸形的有效外科方法。[方法]自2000年8月～2005年7月共收治13例14个股骨纤维结构不良伴重度髋或及股内翻畸形患者，均采用股骨单处或双处外翻截骨矫形、病灶刮除、打压植骨、重建钉内固定治疗。[结果]所有病人随访8～41个月（平均21个月）。X线显示，14个股内翻畸形股骨力线几乎完全矫正；髋内翻畸形的颈干角由术前平均75°（55°～100°）矫正为术后120°（95°～130°）；股骨相对长度由术前平均短缩3．4cm（2．0～4．5cm），矫正后延长2．8cm（1．8～3．6cm）；14个股骨共19处截骨面均达骨性愈合。所有患者植骨区于术后3个月均有不同程度的吸收，术后10—14个月最明显。术前4例患者扶双拐行走，2例扶单杖行走，5例病理性骨折不能行走，2例不扶杖跛行；术后11例患者不扶拐行走，2例扶单杖行走。11例患者疼痛消失，2例疼痛明显减轻。所有患者无感染、畸形进展及再骨折。[结论]（1）该治疗方法能够有效的矫正股骨畸形，恢复股骨生物力学力线，改善患肢功能；（2）能有效的去除病变，防止复发；（3）股骨髓腔内大量打压式植骨是促进骨愈合及防止病理性骨折的关键。

[Objective] To find an effective method of surgical treatment of fibrous dysplasia of bone involving the femur associated with severe varus deformity. [ Method] Thirteen patients with fibrous dysplasia of bone involving 14 femurs with severe varus deformity were reviewed from Feb 2002 and Jul 2005. Medial displacement of valgus or valgus osteotomies, curettage and allograft, reconstructional nail have been adohed to treat fibrous dysplasia of bone involving the femur with severe varus deformity. [Result] All patients were followed up from 8 months to41 months with an average of 21 months. Forteen femoral mechanical alignments （axis） had been corrected completely rdiologically; the preoperative average neck-shaft angle of 75° （range, 55°～100° ）, corrected to the average 120° （range, 95 °～ 135° ） of postoperative, the average shortening of the femur was 3.4 cm （ range, 2. 0 ～ 4. 5 cm） preoperatively, then enlongthened by 2. 8 cm （ range, 1.8 ～ 3. 6 cm） in postoperation. Ninteen location of osteotomies showed good union in 14 femur. All bone grafts were absorbed slightly beginning at 3 months and markedly at 10 to 14 months postoperatively. Preoperation, 4 patients walked with bilateral crutches, 2 used unilateral cane, 5 can＇t walk due to pathological fracture, 2 without support; after operation, 11 patients walk without support, 2 ambulated with the aid of unilateracane. Eleven patients were painless, 2 moderate pain. All had no infections and recurrent fracture and progression of the deformity. [ Conclusion] （1） This method can correct varus deformity, improve function, as well as restore biomechanical axis of femur. （2） It is able to effectively eradicate lesions and prevent recurrence. （3） Impaction allograft is the key of prompting allograft incorporating fully and preventing pathological fracture.