交锁髓内钉固定在股骨近端纤维异样增殖症中的应用  

Application of interlocking intramedullary nailing in fibrous dysplasia of proximal femur

作　　者：陈兆强[1] 杨建平[1] 张中礼[1] 付喆[1] 王侃[1] 邓书贞[1] Chen Zhaoqiang;Yang Jianping;Zhang Zhongli;Fu Zhe;Wang Kan;Deng Shuzhen(Department of Pediatric Orthopaedics,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市天津医院小儿骨科,天津300211

出　　处：《中华骨科杂志》2022年第16期1037-1045,共9页Chinese Journal of Orthopaedics

摘　　要：目的总结交锁髓内钉固定在股骨近端纤维异样增殖症(fibrous dysplasia,FD)的治疗方法和效果,并探讨其应用技术和治疗策略。方法回顾性分析2014年4月至2018年8月31例(32侧)接受交锁髓内钉固定治疗的股骨近端纤维异样增殖症患者资料,其中男24例,女7例;单骨型7例,多骨型24例;手术时年龄(11.4±2.3)岁,随访时间(3.9±1.1)年。手术方式为截骨矫形或原位交锁髓内钉固定,部分股骨颈重建钉经过骺板。比较术前、术后和末次随访时影像学改变,包括股骨颈干角、股骨近端骨干畸形。采用单因素分析术后股骨颈干角丢失的影响因素。结果31例中13例存在髋内翻畸形,颈干角107.3°±7.1°,23例存在股骨近端骨干弯曲畸形,成角29.5°±9.1°,其中10例髋内翻合并股骨近端骨干弯曲畸形行双处截骨内固定,17例单纯髋内翻或骨干弯曲畸形行单处截骨内固定,5例无显著畸形因病理骨折行原位内固定。术后股骨颈干角133.2°±5.2°,股骨近端弯曲畸形完全矫正,股骨力线均在正常范围。末次随访时7例(21.9%,7/32)颈干角由术后133.6°±3.9°,减少到125.7°±3.4°。单因素分析提示股骨近端锁定钉经过骺板病例颈干角丢失比例(0)显著低于未经过骺板固定(43.8%),差异有统计学意义(χ2=6.58,P=0.010)。结论交锁髓内钉应用于股骨近端纤维异样增殖症的治疗可获得良好的效果,根据髋内翻和(或)骨干弯曲畸形情况可行单处或双处截骨矫正;术后存在股骨颈干角丢失的风险,股骨颈重建锁钉经过骺板固定能够规避该风险。Objective To retrospectively analyze and evaluate the effect of interlocking intramedullary nail in the treatment of proximalfemoral fibrous dysplasia(FD)and to discuss its application techniques and treatment strategies.Methods The patients with proximal femoral FD who received treatment with interlocking intramedullary nail in our department from April 2014 to August 2018 were retrospectively reviewed.The inclusion criteria included having complete data with more than 3 years follow-up.A total of 31 cases with 32 thighs were included in the present study.Among them,there were 24 males and 7 females.The mean age at operation was 11.4±2.3 years.The mean follow-up duration was 3.9±1.1 years.The surgical methods were osteotomy or in situ interlocking intramedullary nailing,and femoral neck reconstruction nails pass through the epiphyseal plate in some cases.Preoperative,postoperative and final follow-up radiographic changes,including femoral neck shaft angle,proximal femoral diaphyseal deformity,and femoral alignment were compared.Univariate analysis of the influencing factors of postoperative femoral neck shaft angle loss.Results In this group,13 patients had coxa varus deformity,and the angle of the neck shaft was 107.3±7.1°,and 23 patients had the bending deformity of the proximal femur,and angled 29.5°±9.1°.10 cases of coxa varus combined with proximal femoral diaphyseal deformity received double osteotomy and internal fixation,17cases of simple coxa varus or diaphyseal deformity received single osteotomy and internal fixation,and 5 cases had no significant deformity,underwent in situ intramedullary nailing due to pathological fractures and pain.Postoperative femoral neck shaft angle was 133.2°±5.2°.Complete correction of proximal femoral flexion deformity was obtained and the diaphyseal axis was within the normal range.At the last follow-up,the neck shaft angle of 7 patients(21.9%,7/32)decreased from 133.6°±3.9°to 125.7°±3.4°.Univariate analysis showed that the proportion of neck shaft angle lo

关 键 词：髋内翻 截骨术 内固定器 治疗结果 

分 类 号：R726.8[医药卫生—儿科]