股骨近端纤维结构不良的手术治疗  

Surgical treatment of fibrous dysplasia in proximal femur

作　　者：同志超[1] 王坤正[2] 焦宁[1] 杨团民[1] 张文[1] 陈博[1] 

机构地区：[1]西安市红十字会医院骨病科,陕西西安710054 [2]西安交通大学第二医院骨科

出　　处：《中国骨伤》2011年第4期345-348,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的:通过对股骨近端纤维结构不良病例进行回顾性研究,总结肿瘤学和功能学结果,探讨其治疗方法及效果。方法:2007年4月至2009年1月,收治15例股骨近端纤维结构不良患者,男9例,女6例;年龄16～32岁,平均25岁;单侧病变12例,双侧病变3例;单骨型12例,多骨型3例;病程2个月～16年,平均2年。股骨近端纤维结构不良伴髋内翻2例,颈干角分别为80°和100°,股骨长度较对侧短缩分别为5cm和3cm。所有患者采用病灶刮除、打压植骨(同种异体人工骨和/或自体髂骨)、内固定治疗,其中2例牧羊拐畸形者采用外翻截骨矫形术。结果:所有患者获随访,时间12～32个月,2例股骨近端牧羊拐畸形患者经截骨矫形后畸形矫正,颈干角恢复,股骨长度延长分别为4cm和3cm,术后4个月扶双拐下地行走。所有患者术后病变无复发及内固定物松动,植骨区术后3个月可见局部骨吸收,术后8～12个月植骨区骨愈合,疼痛消失,步态正常。结论:彻底刮除病灶、植骨及有效内固定是治疗股骨近端纤维结构不良的有效方法,对伴有牧羊拐畸形者应同时行外翻截骨以恢复髋关节功能。Objective：To summarize the oncological and functional results of patients with fibrous dysplasia in the proximal femur and explore its clinical effect.Methods：From Apr.2007 to Jan.2009,15 patients with fibrous dysplasia in proximal femur were treated.There were 9 males and 6 females,ranging in age from 16 to 32 years with an average of 25 years.The course of disease was from 2 months to 16 years with an average of 2 years.Among them,12 cases were unilateral affection and 3 cases were hibateral affections;12 cases were one bone and 3 cases more than two bones.The collodiaphyseal angles of 2 cases with coxa adducta was 80°and 100° respectively;and femur lengths were shorter than opposite side（5 cm and 3 cm,respectively）.The curettage and allogenous and/or autogenous bone-grafting combined with internal fixation were performed in all patients and valgus osteotomies was performed in 2 case with shepherd＇s crook deformity.Results：All patients were followed up from 12 to 32 months.Two cases with shepherd＇s crook deformity,the collodiaphyseal angles recovered after surgery,the relative length of femur was increased 4 cm and 3 cm respectively and they can walk with stick at 4 months after operation.No found recurrence and loosening of internal fixation.Bone graft was absorbed at 3 months and bone healing at 8-12 months after operation.The pain vanished and functions were normal.Conclusion：It is an effective method to treat fibrous dysplasia in proximal fumur with curettage and bone-grafting combined with internal fixation.Corrective osteotomy and internal fixation with a dynamic hip screw is a good and effective method in treating severe symptomatic shepherd＇s crook deformity.

关 键 词：股骨 骨移植 刮除术 截骨术 

分 类 号：R738.102[医药卫生—肿瘤]