Guille J T, Kumar S J, MacEwen G D
Department of Orthopaedic Surgery, Allegheny University Hospitals, Philadelphia, Pennsylvania 19102, USA.
J Bone Joint Surg Am. 1998 May;80(5):648-58. doi: 10.2106/00004623-199805000-00005.
We reviewed the long-term outcomes of treatment of fibrous dysplasia of the proximal part of the femur in twenty-two patients (twenty-seven femora). There were fifteen male patients and seven female patients. Patients who had monostotic disease had no involvement of the calcar femorale, fewer microfractures, less deformity, and stronger bone that could support internal fixation. Patients who had polyostotic disease had frequent involvement of the calcar femorale; more microfractures; severe deformity, including shepherd's crook deformity; and, in many instances, bone that could not support internal fixation. Twenty-two of the twenty-seven femora had a microfracture at the time of the initial presentation. At least one osteotomy was performed in four femora that had monostotic disease and in nine femora that had polyostotic disease. Curettage and cancellous or cortical bone-grafting did not appear to have any advantage compared with osteotomy alone in the treatment of symptomatic lesions, as all grafts resorbed with persistence of the lesion. At the time of the latest follow-up evaluation, no lesion had been eradicated or had decreased in size. A satisfactory clinical result was achieved in twenty patients (twenty-four femora): nine who had monostotic disease and eleven who had polyostotic disease. Two patients who had polyostotic disease and an endocrinopathy (one of whom had bilateral involvement) had an unsatisfactory result. All three femora in these two patients had a neck-shaft angle of less than 90 degrees at the time of the most recent follow-up evaluation. Varus deformity of the proximal part of the femur is best treated with valgus osteotomy and internal fixation early in the course of the disease. If the calcar of the femoral neck is involved or if the quality of the bone is such that internal fixation is not possible, a medial displacement valgus osteotomy can provide a more mechanically favorable position for healing of the microfracture.
我们回顾了22例患者（27个股骨）股骨近端纤维发育不良的长期治疗结果。其中男性患者15例，女性患者7例。单骨型病变患者的股骨距未受累，微骨折较少，畸形较轻，且骨质较强，能够支持内固定。多骨型病变患者的股骨距常受累；微骨折较多；畸形严重，包括牧羊人手杖样畸形；而且在许多情况下，骨质无法支持内固定。27个股骨中有22个在初次就诊时就存在微骨折。4例单骨型病变的股骨和9例多骨型病变的股骨至少接受了一次截骨术。在治疗有症状的病变时，与单纯截骨术相比，刮除术加松质骨或皮质骨移植似乎并无任何优势，因为所有移植骨均吸收，病变持续存在。在最近一次随访评估时，没有病变被根除或缩小。20例患者（24个股骨）取得了满意的临床结果：9例单骨型病变患者和11例多骨型病变患者。2例患有多骨型病变且有内分泌病的患者（其中1例为双侧受累）结果不满意。在最近一次随访评估时，这2例患者的所有3个股骨的颈干角均小于90度。股骨近端内翻畸形在疾病早期最好采用外翻截骨术和内固定治疗。如果股骨颈的股骨距受累，或者骨质质量差以至于无法进行内固定，内侧移位外翻截骨术可为微骨折愈合提供更有利的力学位置。
