Fang Xiang, Liu Hongyuan, Lang Yun, Xiong Yan, Duan Hong
Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610064, P.R. China.
Department of Orthopedics, People's Hospital of Deyang City, Deyang, Sichuan 618000, P.R. China.
Mol Clin Oncol. 2018 Jul;9(1):98-103. doi: 10.3892/mco.2018.1636. Epub 2018 May 21.
The surgical treatment for fibrous dysplasia (FD) of bone is problematic due to its variable clinical courses. And multifarious surgical treatment options have been reported while no consistent view can be reached. Therefore, we reviewed a series of 22 patients (11 males and 11 females; mean age 28.4 years, range 15-48 years) with FD between December 2011 and July 2015. Fourteen patients had monostotic fibrous dysplasia (MFD) and eight patients had polyostotic fibrous dysplasia (PFD) with nine lesions. All patients were followed up from 15 to 58 months with an average of 26.0 months. Functional and radiographic outcomes were recorded. In the MFD group, four patients were treated with curettage and bone grafting without internal fixation and nine were treated with curettage and bone grafting with internal fixations. Osteotomy and intramedullary (IM) nail was applied in one patient with serious deformity. In the PFD group, three deformity lesions were treated with osteotomy and proximal femoral nail anti-rotation (PFNA). IM were also applied in six large lesions to treat fracture or prevent deformity. One lesion in tibia were treated with only curettage and bone graft. No complication was observed in MFD group and satisfactory union and functional outcomes acquired during follow-up period. In the PFD group, the spiral blade cutting out from femoral head in PFNA was observed in one patient and treated with revision surgery. No other complication occurred, and satisfactory radiological and functional outcome were observed. The severity of both MFD and PFD are related to size, site and of the lesion. The goal of the surgery is to eliminate pain, correct deformity and treat pathological fracture. Curettage, bone grafting with internal fixation is recommended for treating large lesions with deformity or high pathological fracture risk. PFNA or IM nail is prior in osteotomy with better clinical outcome.
由于骨纤维异常增殖症（FD）临床病程多变，其外科治疗存在问题。虽然已有多种外科治疗方案的报道，但尚未达成一致意见。因此，我们回顾了2011年12月至2015年7月期间收治的22例FD患者（男11例，女11例；平均年龄28.4岁，范围15 - 48岁）。其中14例为单骨型纤维异常增殖症（MFD），8例为多骨型纤维异常增殖症（PFD）共9处病变。所有患者随访15至58个月，平均26.0个月。记录功能和影像学结果。在MFD组，4例患者采用刮除植骨术未行内固定，9例采用刮除植骨术并内固定。1例严重畸形患者行截骨术并髓内（IM）钉固定。在PFD组，3处畸形病变采用截骨术及股骨近端抗旋髓内钉（PFNA）治疗。6处大病变也采用IM钉治疗以治疗骨折或预防畸形。1例胫骨病变仅行刮除植骨术。MFD组未观察到并发症，随访期间获得满意的愈合和功能结果。在PFD组，1例患者观察到PFNA的螺旋刀片穿出股骨头，行翻修手术治疗。未发生其他并发症，观察到满意的影像学和功能结果。MFD和PFD的严重程度均与病变的大小、部位有关。手术的目标是消除疼痛、矫正畸形和治疗病理性骨折。对于有畸形或高病理性骨折风险的大病变，建议采用刮除植骨并内固定治疗。截骨术时优先选择PFNA或IM钉，临床效果更佳。
