Seoul National University Hospital, Department of Orthopaedic Surgery, 101 Daehak-ro Jongno-gu, Seoul, 110-744, South Korea.
Bone Joint J. 2014 May;96-B(5):673-6. doi: 10.1302/0301-620X.96B5.33281.
Monostotic fibrous dysplasia of the proximal femur has a variable clinical course, despite its reported limited tendency to progress. We investigated the natural history and predisposing factors for progression of dysplasia in a group of 76 patients with a mean follow-up of 8.5 years (2.0 to 15.2). Of these, 31 (41%) presented with an asymptomatic incidental lesion while 45 (59%) presented with pain or a pathological fracture. A group of 23 patients (30%) underwent early operative treatment for pain (19: 25%) or pathological fracture (4: 5%). Of the 53 patients who were initially treated non-operatively, 45 (85%) remained asymptomatic but eight (15%) needed surgery because of pain or fracture. The progression-free survival of the observation group was 81% (sd 6.4%) at five-years follow-up. An initial presentation of pain (p < 0.001), a limp (p < 0.001), radiological evidence of microfracture (p = 0.001) and younger age (< 17 years) (p = 0.016) were significant predisposing factors for disease progression. The risk of experiencing pain or pathological fracture is considerable in monostotic fibrous dysplasia of the proximal femur. Patients presenting with pain, a limp or radiological evidence of microfracture have a high chance of needing surgical treatment.
股骨近端单骨性纤维结构不良的临床表现具有多变性，尽管其被报道进展的趋势有限。我们研究了一组 76 例患者的自然病史和进展的易感因素，平均随访时间为 8.5 年（2.0 至 15.2 年）。其中 31 例（41%）为无症状偶然发现的病变，而 45 例（59%）为疼痛或病理性骨折。23 例（30%）患者因疼痛（19 例：25%）或病理性骨折（4 例：5%）而接受早期手术治疗。在最初非手术治疗的 53 例患者中，45 例（85%）仍无症状，但有 8 例（15%）因疼痛或骨折需要手术。观察组的无进展生存率为 5 年随访时的 81%（标准差 6.4%）。初始表现为疼痛（p<0.001）、跛行（p<0.001）、影像学微骨折证据（p=0.001）和年龄较小（<17 岁）（p=0.016）是疾病进展的显著易感因素。在股骨近端单骨性纤维结构不良中，出现疼痛或病理性骨折的风险相当大。出现疼痛、跛行或影像学微骨折证据的患者有很大的机会需要手术治疗。
