手术治疗儿童股骨近端骨纤维异样增殖症的初步探讨  

Preliminary results of surgical treatment of fibrous dysplasia of proximal femur in children

作　　者：边臻[1] 郭源[1] 朱振华[1] 吕学敏[1] 傅刚[1] 杨征[1] Bian Zhen;Guo Yuan;Zhu Zhenhua;Lyu Xuemin;Fu Gang;Yang Zheng(Department of Pediatric Orthopaedics,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院小儿骨科,100035

出　　处：《中华外科杂志》2021年第9期730-736,共7页Chinese Journal of Surgery

基　　金：北京市自然科学基金(7182067);北京积水潭医院“学科骨干”计划专项经费(XKGG201809)。

摘　　要：目的探讨儿童股骨近端骨纤维异样增殖症的手术治疗方式、临床效果及翻修原因。方法回顾性分析2016年6月至2018年6月于北京积水潭医院小儿骨科行手术治疗的26例股骨近端多骨型骨纤维异样增殖症患儿的临床资料。男18例,女8例,平均年龄9.2岁(范围:5~16岁),其中1例为McCune-Albright综合征。15例患儿为首次手术,11例患儿为翻修手术;手术方式采用带锁髓内钉或儿童髋钢板固定。观察26例患儿的手术效果并分析其中11例行翻修手术患儿的畸形复发原因。结果行初次手术的15例患儿中,13例行截骨或骨折复位+带锁髓内钉固定;1例行外翻截骨+儿童髋钢板内固定;1例行外翻截骨+病灶刮除+异体骨植骨+儿童髋钢板内固定。行翻修手术的11例患儿中,9例行带锁髓内钉固定、1例行儿童髋钢板内固定、1例行儿童髋钢板内固定+异体骨植骨。所有患儿均获得随访,平均随访1.4年(范围:1.0~3.5年),患儿截骨或骨折端愈合良好,畸形矫正满意,疼痛症状消失。术后发生感染1例,局部骨吸收1例,无其他并发症发生。11例翻修患儿在既往16次手术后复发,复发原因包括带锁髓内钉远端失效6例次,带锁髓内钉近端失效3例次,钢板固定失效5例次,病灶刮除人工骨植骨术后复发2例次。结论截骨矫形辅以坚强内固定支撑是治疗儿童股骨近端骨纤维异样增殖症的有效手术方法,以带锁髓内钉最为常用。由于生长发育、疾病进展等原因导致内固定失效是畸形复发导致翻修的主要原因,需术后密切随访。Objective To investigate the surgical treatment,clinical effect and revision reasons of children with proximal femoral fibrous dysplasia(FD).Methods 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.Results 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.Conclusions 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.

关 键 词：儿童 截骨术 骨纤维异样增殖症 多段截骨 复发 

分 类 号：R726.8[医药卫生—儿科]