Dheenadhayalan Jayaramaraju, Avinash M, Lakhani Azhar, Rajasekaran S
Department of Orthopaedics and Traumatology, Ganga Hospital, Coimbatore, Tamil Nadu, India.
J Orthop Surg (Hong Kong). 2019 Jan-Apr;27(1):2309499019834362. doi: 10.1177/2309499019834362.
Fibrous dysplasia (FD) of the proximal femur can result in severe deformity and disability. The results of surgical management in such situations have been reported to be poor. We present a novel, five-step surgical treatment to correct proximal femoral deformity in FD.
This study is a review of prospectively collected data of cases of proximal femur polyostotic FD managed at our institute from 2012 onward. We managed three patients with FD involving four femora (one patient had bilateral disease). Mean age at presentation was 16 years with an average follow-up of 46 months. All underwent five steps, that is, (1) curettage/excision of the lesion, (2) allograft in intramedullary region, (3) lateral closing wedge valgus osteotomy, (4) fixation with extramedullary implant, and (5) augmentation of osteotomy site with autograft. Functional outcome was assessed using Harris Hip Score preoperatively and at the final follow-up.
The neck shaft angle was corrected from an average of 91.7° to 152.1°, while the Harris Hip Score improved from an average of 59 to 95. There was no clinical or radiological evidence of recurrence of disease or deformity in any patient till the last follow-up.
This five-step technique ensures good functional and radiological outcomes in the management of proximal femur FD.
股骨近端骨纤维异常增殖症（FD）可导致严重畸形和残疾。据报道，在这种情况下手术治疗的效果不佳。我们提出一种新颖的五步手术治疗方法来矫正FD患者的股骨近端畸形。
本研究回顾了自2012年起在我院接受治疗的股骨近端多骨型FD病例的前瞻性收集数据。我们治疗了3例FD患者，累及4个股骨（1例为双侧患病）。就诊时的平均年龄为16岁，平均随访46个月。所有患者均接受了五个步骤的治疗，即：（1）病灶刮除/切除；（2）髓腔内同种异体骨移植；（3）外侧闭合楔形外翻截骨；（4）髓外植入物固定；（5）自体骨移植增加截骨部位。术前及末次随访时采用Harris髋关节评分评估功能结局。
颈干角从平均91.7°矫正至152.1°，Harris髋关节评分从平均59分提高到95分。直至末次随访，所有患者均无疾病复发或畸形的临床及影像学证据。
这种五步技术在股骨近端FD的治疗中可确保良好的功能和影像学效果。
