Ebeid Walid Atef, Hasan Bahaa Zakarya, Mesregah Mohamed Kamal
Orthopedic Surgery Department, Cairo University, Cairo, Egypt (Dr. Ebeid), the Orthopedic Surgery Department, Menoufia University, Menoufia, Egypt (Dr. Hasan and Mesregah), and the Orthopedic Surgery Department, Keck School of Medicine, University of Southern California, Los Angeles, California (Dr. Mesregah).
J Am Acad Orthop Surg Glob Res Rev. 2018 Oct 2;2(10):e057. doi: 10.5435/JAAOSGlobal-D-18-00057. eCollection 2018 Oct.
This paper assesses whether treating patients with fibrous dysplasia of proximal femur by internal fixation with correction of the deformity, if present, without grafting is enough or not.
This study is a retrospective study using patient's medical records, including analysis of 19 patients with fibrous dysplasia of proximal femur treated by internal fixation only and followed up between 2000 and 2017 for at least 2 years. Epidemiologic data, clinical manifestations, radiologic and histologic investigations, surgery, functional outcomes, and complications in these patients were analyzed.
The study included 12 male patients and 7 female patients, with a mean age of 20.74 years. Of these, two patients presented with pathologic fractures, two presented with shepherd's crook deformity, and the remaining presented with hip pain and limping. Implants used for internal fixation were intramedullary nail in four patients, dynamic hip screw in eight patients, cannulated screws in four patients, broad dynamic compression plate in two patients, and narrow dynamic compression plate in one patient. The mean follow-up period was 53.58 months. Four patients had postoperative complications. The mean Musculoskeletal Tumor Society score was 27.63 points.
The optimal management option for fibrous dysplasia of proximal femur is debatable. We suggest that internal fixation without grafting has a good local control and satisfactory functional long-term outcome.
本文评估对于股骨近端骨纤维异常增殖症患者，在不进行植骨的情况下，通过内固定并矫正畸形（若存在畸形）进行治疗是否足够。
本研究为回顾性研究，使用患者病历，包括对19例仅接受内固定治疗的股骨近端骨纤维异常增殖症患者进行分析，这些患者在2000年至2017年期间接受随访，随访时间至少为2年。分析了这些患者的流行病学数据、临床表现、放射学和组织学检查、手术情况、功能结果及并发症。
该研究纳入12例男性患者和7例女性患者，平均年龄为20.74岁。其中，2例患者出现病理性骨折，2例出现牧羊拐畸形，其余患者表现为髋关节疼痛和跛行。用于内固定的植入物包括4例患者使用髓内钉，8例患者使用动力髋螺钉，4例患者使用空心螺钉，2例患者使用宽动力加压钢板，1例患者使用窄动力加压钢板。平均随访期为53.58个月。4例患者出现术后并发症。肌肉骨骼肿瘤学会平均评分为27.63分。
股骨近端骨纤维异常增殖症的最佳治疗方案存在争议。我们认为，不进行植骨的内固定具有良好的局部控制效果和令人满意的长期功能结果。
