股骨近端骨纤维结构不良伴严重内翻畸形的矫形

Orthopedic surgical treatment for fibrous dysplasia of the proximal part of the femur combined with serious varus deformity

目的探讨严重内翻畸形的股骨近端骨纤维结构不良(fibrous dysplasia,FD)的治疗方法。方法 2001年1月至2011年12月,收治26例股骨近端严重髋内翻伴肢体短缩畸形的FD患者。颈干角35°～100°,平均78°,股骨相对长度较对侧短缩2.0～9.5cm,平均4.2cm。26例均行股骨近端畸形顶点附近外翻截骨,股骨头、颈及截骨断端打压式植骨,嵌插复位DHS或DCS钢板固定。结果术后23例获得随访,随访时间6个月至10.5年,平均4.8年。22例内固定可靠,1例DHS内固定物股骨头螺纹钉术后1年切割出股骨头2mm,疼痛,经取出内固定物后治愈。股骨力线均基本矫正,截骨面达骨性愈合,髋内翻畸形的颈干角矫正为95°～130°,平均119°,股骨相对长度矫正后较术前延长2.5～8.6cm,平均3.7cm,术前肢体短缩基本纠正。术后17例患者步态正常;2例扶单拐行走,5例不扶拐轻度跛行。术后19例疼痛消失,4例疼痛明显减轻。所有患者无感染、再骨折和畸形进展。结论股骨近端FD严重髋内翻伴肢体短缩畸形行股骨近端畸形顶点附近外翻截骨,股骨头、颈及截骨断端打压式植骨,嵌插复位DHS或DCS钢板固定是一个简单有效的治疗方法。同时,股骨近端加长的DHS或DCS钢板对FD患者的骨质结构有明显的加强作用,特别是维持股骨近端及颈干角的解剖力线能起到很大的作用,以避免畸形复发。

Objective To investigate the treatment method for fibrous dysplasia （FD） of the proximal part of the femur combined with serious varus deformity. Methods From January 2001 to December 2011, 26 patients with FD of the proximal part of the femur combined with serious coxa vara and limb reduction deformities were adopted by our department. The mean femoral neck-shaft angle was 78° （range; 35°-100°）. The femoral relative length was 4.2cm shorter on average （range; 2.0-9.5cm） than that of the opposite side. All patients were operated with valgus osteotomy around the deformity apex in the proximal part of the femur, impacted bone graft in the femoral head and neck and osteotomy end, and internal fixation of dynamic hip screw （DHS） and dynamic condylar screw （DCS）. Results Postoperatively 23 patients were followed up for an average period of 4.8 years （range; 0.5-10.5 years）. The internal fixation for 22 patients was stable, and 1 patient with internal fixation of DHS was cured after dismantling the internal fixation 1 year after surgery, because 2mm of the femoral head was cut by the screw and the patient felt painful. The mechanical axis of the femur was just corrected, and all patients got bone healing. Postoperatively the neck-shaft angle was corrected to 119° on average （range; 95°-130°） and the average relative length of the femur increased by 3.7cm （range; 2.5-8.6cm）. The preoperative shortened limbs were just corrected. After surgery, 17 patients could walk normally, 2 ambulated with a unilateral cane and 5 were slightly limping without support. Pain disappeared in 19 patients, and pain was significantly improved in 4 patients. No infection, refraeture or progression of the deformity occurred in all patients. Conclusions Patients with FD in the proximal part of the femur combined with serious coxa varus and limb reduction deformities are operated with valgus osteotomy around the deformity apex in the proximal part of the femur, impacted bone graft in the femoral head and neck and osteotomy end, and internal fixation of DHS and DCS, which is an effective treatment method. And meanwhile, the DHS or DCS plates in the proximal part of the femur can strengthen bone structure of the patients with FD, and especially restore the biomechanical axis of the proximal part of the femur and neck-shaft angle, so as to prevent recurrence of the deformity.