Bian Z, Guo Y, Zhu Z H, Lv X M, Fu G, Yang Z
Department of Pediatric Orthopaedics,Beijing Jishuitan Hospital,Beijing 100035,China.
Zhonghua Wai Ke Za Zhi. 2021 Sep 1;59(9):731-737. doi: 10.3760/cma.j.cn112139-20210307-00113.
To investigate the surgical treatment, clinical effect and revision reasons of children with proximal femoral fibrous dysplasia(FD). The clinical data of 26 children with polyostotic FD of proximal femur who underwent surgery at Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital from June 2016 to June 2018 were retrospectively analyzed. There were 18 males and 8 females with a mean age of 9.2 years (range:5 to 16 years).One of them was McCune Albright syndrome. Fifteen cases were in first operation and 11 cases were in revision operation. The operation methods and results were reviewed,and the causes of revision were analyzed. Among the 15 children who underwent the first operation,13 cases underwent osteotomy or fracture reduction and interlocking intramedullary nail(IMN) fixation;One case underwent valgus osteotomy and pediatric hip plate(PHP)internal fixation;One case underwent valgus osteotomy+lesion curettage+allogeneic bone graft+PHP fixation. Among the 11 children who underwent revision surgery,9 cases were treated with IMN fixation,1 case with PHP fixation,and 1 case with PHP fixation+allogeneic bone graft. The causes of revision included distal fixation failed in 6 cases,proximal fixation failed in 3 cases,plate fixation failed in 5 cases,and recurrence occurred after curettage and artificial bone graft in 2 cases. Patients were followed up for 1.4 years(range:1.0 to 3.5 years) after recent operation. The osteotomy or fracture healed well with good deformity correction. Postoperative complications included infection in 1 case and local bone partial resorption in 1 case. Osteotomy combined with rigid internal fixation is an effective surgical treatment for fibrous dysplasia of proximal femur in children. Internal fixation should cover the whole length of lesion. Intramedullary nail is the most common choice. Because the growth of height and the progress of the disease itself,this deformity is prone to recur in children,needing closely follow-up after operation.
探讨儿童股骨近端纤维结构不良（FD）的手术治疗方法、临床疗效及翻修原因。回顾性分析2016年6月至2018年6月在北京积水潭医院小儿骨科接受手术的26例股骨近端多骨型FD患儿的临床资料。其中男18例，女8例，平均年龄9.2岁（范围：5至16岁）。其中1例为McCune Albright综合征。初次手术15例，翻修手术11例。回顾手术方法及结果，分析翻修原因。在初次手术的15例患儿中，13例行截骨或骨折复位及带锁髓内钉（IMN）固定；1例行外翻截骨及儿童髋关节钢板（PHP）内固定；1例行外翻截骨+病灶刮除+异体骨移植+PHP固定。在接受翻修手术的11例患儿中，9例采用IMN固定，1例采用PHP固定，1例采用PHP固定+异体骨移植。翻修原因包括远端固定失败6例，近端固定失败3例，钢板固定失败5例，刮除及人工骨移植后复发2例。近期手术后对患者进行了1.4年（范围：1.0至3.5年）的随访。截骨或骨折愈合良好，畸形矫正效果良好。术后并发症包括感染1例，局部骨质部分吸收1例。截骨联合坚强内固定是治疗儿童股骨近端纤维结构不良的有效手术方法。内固定应覆盖病变全长。髓内钉是最常用的选择。由于儿童身高增长及疾病本身进展，该畸形易于复发，术后需密切随访。
