Li Tao, Xing Binbin, Duan Hong, Liu Yang, Pei Fuxing, Tu Chongqi
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Mar;23(3):261-4.
To find an effective method of surgical treatment of fibrous dysplasia of bone involving the proximal femur.
From January 2001 to January 2006, 57 patients with fibrous dysplasia of bone involving the proximal femur were treated. There were 29 males and 28 females, aging 8-50 years (mean 22 years). Thirty-five patients were involved one bone and 22 patients were involved more than two bones. According to Guille's classification, 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 degrees on average (55-100 degrees). 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 the extent 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 fixation was performed. Medial displacement valgus or valgus osteotomies were used to treat fibrous dysplasia of bone involving the proximal part of the femur with coax varus.
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 degrees (55-100 degrees) preoperatively to 122 degrees (95-130 degrees) 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.
Impaction allograft is the key of prompting allograft incorporating fully and preventing pathological fracture. An effective internal fixation 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
探寻一种治疗累及股骨近端的骨纤维异常增殖症的有效手术方法。
2001年1月至2006年1月，对57例累及股骨近端的骨纤维异常增殖症患者进行治疗。其中男性29例，女性28例，年龄8 - 50岁（平均22岁）。35例累及单骨，22例累及两块以上骨骼。根据吉勒（Guille）分类，A型34例，B型8例，C型8例，D型7例。14例合并髋内翻，股骨颈干角平均为78度（55 - 100度）。病程平均为2.3年（4个月至10年）。各种手术方式的选择取决于骨质质量和病变范围。骨质良好时，行刮除植骨术；骨质不佳时，行刮除植骨术并结合内固定。采用内移截骨或外翻截骨术治疗合并髋内翻的累及股骨近端的骨纤维异常增殖症。
所有患者随访6个月至5年，平均2.8年。所有植骨在术后3个月有轻微吸收，10至14个月吸收明显。合并髋内翻的患者股骨力学对线在影像学上完全矫正；平均颈干角从术前的78度（55 - 100度）矫正至术后的122度（95 - 130度）。股骨相对长度增加1.8 - 3.6厘米（平均2.7厘米）。术后，49例患者可独立行走，5例跛行，3例需借助单拐行走。52例患者疼痛消失，5例患者疼痛改善。所有患者均未发生感染、骨折复发及畸形进展。
嵌入植骨是促使植骨充分融合并防止病理性骨折的关键。骨质不佳时必须采用有效的内固定。内移截骨或外翻截骨可矫正内翻畸形，改善功能，恢复股骨生物力学轴线。还能有效根除病变并预防……
