股骨近端骨纤维结构不良的外科治疗

SURGICAL TREATMENT FOR FIBROUS DYSPLASIA OF BONE INVOLVING PROXIMAL FEMUR

目的探讨股骨近端骨纤维结构不良(fibrous dysplasia,FD)的有效治疗方法。方法2001年1月-2006年1月,收治57例股骨近端FD患者。男29例,女28例;年龄8～50岁,平均22岁。单侧55例,双侧2例。单骨型35例,多骨型22例。按Guille分型:A型34例,B型8例,C型8例,D型7例。股骨近端FD伴髋内翻畸形14例,颈干角55～100°,平均78°,股骨相对长度较对侧短缩2.0～4.5cm,平均3.2cm。病程4个月～10年,平均2.3年。股骨近端病变范围小、骨强度佳者,采用单纯病变刮除、打压式同种异体植骨14例;病变范围大、骨强度不佳者,采用病变刮除、打压式同种异体骨植骨、内固定43例,其中伴髋内翻畸形者,同时行外翻或内移外翻截骨矫形术。结果术后57例均获随访,随访时间6个月～5年,平均2.8年。2例单纯病变刮除打压式植骨A型患者术后复发,经再次病变刮除、植骨、重建钉内固定后治愈;1例病变刮除打压式植骨联合内固定A型患者动力髁螺钉内固定物松动,经更换为重建钉后治愈。植骨区术后3个月均有轻度骨吸收,10～14个月植骨区骨结构渐致密。股骨近端FD伴髋内翻畸形股骨力线均完全矫正,截骨面均达骨性愈合,髋内翻畸形的颈干角矫正为95～130°,平均122°,股骨相对长度矫正后较术前延长1.8～3.6cm,平均2.7cm。术后49例患者步态正常;3例扶单拐行走,5例不扶拐跛行。52例疼痛消失,5例A型疼痛明显减轻。结论病变刮除、髓腔内打压式植骨可有效恢复骨量、促进骨愈合及防止病理性骨折;病变范围大或骨强度不佳者,须联合有效内固定;伴有髋内翻畸形者,应同时截骨恢复股骨生物力线。

Objective To nd an effective method of surgical treatment of brous dysplasia of bone involving the proximal femur. Methods From January 2001 to January 2006,57 patients with brous dysplasia of bone involving the proximal femur were treated. There were 29 males and 28 females,aging 8-50 years （mean 22 years）. Thirty-ve patients were involved one bone and 22 patients were involved more than two bones. According to Guille’s classi cation,there were 34 cases of type A,8 cases of type B,8 cases of type C and 7 cases of type D. Fourteen cases complicated by coax varus and the neck-shaft angle of femur was 78° on average （55-100°）. The duration of the disease was 2.3 years on average （4 months to 10 years）. The choice of the various operative procedures depended on the quality of the bone and theffextent of the lesion. When the quality of the bone was good,then curettage and bone-grafting was performed. When the quality of the bone was poor,curettage and bone-grafting combined with internal xation was performed. Medial displacement valgus or valgus osteotomies were used to treat brous dysplasia of bone involving the proximal part of the femur with coax varus. Results All patients were followed up for 6 months to 5 years with an average of 2.8 years. All bone graft were absorbed slightly at 3 months and markedly at 10 to 14 months postoperatively. The femoral mechanical alignments were corrected completely radiologically in patients complicated by coax varus; the average neck-shaft angle was corrected from 78° （55-100°） preoperatively to 122° （95-130°） postoperatively. The relative length of femur was increased 1.8-3.6 cm （mean 2.7 cm）. After operation,49 patients could walk without support,5 with claudication,3 ambulated with the aid of unilateral cane. Pain disappeared in 52 patients and pain was improved in 5 patients. No infections and recurrent fracture and progression of the deformity occurred in all patients. Conclusion Impaction allograft is the key of prompting allograft incorporating fully and preventing pathological fracture. An effective internal xation must be used when the quality of the bone is poor. Medial displacement valgus or varus osteotomies can correct varus deformity,improve function,as well as restore biomechanical axis of femur. It is also able to effectively eradicate lesions and prevent recurrence.