股骨近段骨纤维发育不良合并髋内翻畸形的外科治疗  

Surgical treatment of proximal femoral fibrous dysplasia with coxa vara

作　　者：徐海荣[1] 李远[1] 牛晓辉[1] XU Hai-rong;LI Yuan;NIU Xiao-hui(Department ofOrthopaedic Oncology Surgery,Bejing Ji Shui Tan Hospital,Bejing,100035,China)

机构地区：[1]北京积水潭医院骨肿瘤科,100035

出　　处：《中国骨与关节杂志》2022年第8期579-583,共5页Chinese Journal of Bone and Joint

基　　金：希思科-青年创新肿瘤研究基金(Y-Young2020-0456)。

摘　　要：目的 股骨近段骨纤维发育不良合并髋内翻畸形的外科治疗存在挑战。本研究的目的是评价股骨近段截骨矫形、部分病灶刮除、骨水泥填充、动力髋螺钉(dynamic hip screw,DHS)对纠正髋内翻畸形和跛行步态的长期治疗效果。方法 回顾分析了2006年1月至2016年12月,经治的39例股骨近段骨纤维发育不良合并髋内翻畸形患者。手术采用截骨矫形矫正髋内翻畸形。对股骨头颈和股骨近段病变进行部分病灶刮除,填充骨水泥,采用DHS进行内固定。记录出血量和手术时间。比较术前和术后颈干角、双侧下肢长度的差异、Trendelenburg试验变化情况。评价术后MSTS功能状况。结果 手术时间120~330 min,平均209 min;术中出血量400~5000ml,平均1900ml;随访24~144个月,平均68.6个月;颈干角:术前41°~109°,平均81.9°,术后112°~137°,平均128.9°(P <0.001);双侧下肢的长度差:术前0~65 mm,平均25.0mm,术后平均18.5mm (P=0.004);术前39例Trendelenburg试验均为阳性,最后一次复查时阴性28例,占71.8%(28/39);术后MSTS功能28~30分,平均29.7分。结论 股骨近段截骨矫形、病灶刮除、骨水泥填充、DHS治疗股骨近段骨纤维发育不良合并髋内翻畸形远期疗效好,值得进一步临床应用和研究。Objective The treatment of proximal femoral fibrous dysplasia with coxa vara remains quite challenging.The purpose of this research is to evaluate long-term treatment outcomes of osteotomy correction,lesion curettage,and dynamic hip screw (DHS) with polymethylmethacrylate (PMMA) augmentation.Methods From January 2006 to December 2016,39 cases of proximal femoral fibrous dysplasia with coxa vara were analyzed retrospectively.The hip varus deformity was corrected by osteotomy.The lesions of femoral head and neck and proximal femur were scraped,filled with PMMA and fixed with DHS.The amount of blood loss and the time of surgery were recorded.The Trendelenburg test was performed to compare the preoperative and postoperative differences.The collo-diaphysial angle and the discrepancy of lower limb length were also compared.The functional status of MSTS was evaluated.Results The average operation time was 209 minutes (range:120-330 minutes);the average amount of blood loss during operation was 1900 ml (range:400-5000 ml);the mean follow-up was 68.6 months (range:24-141 months).The collo-diaphysial angle was significantly improved from 81.9° (range:41°-109°) to 128.9° (range:112°-137°) (P < 0.001).The discrepancy of lower limb length was decreased from 25.0 mm(range:0-65 mm) before operation to 18.5 mm (range:0-55 mm) after operation (P=0.004).The Trendelenburg test was positive in 39 patients before operation,while negative in 28 (71.8%) patients at the latest follow-up.The average MSTS score was 29.7 (range:28-30).Conclusions The treatment of osteotomy correction,lesion curettage,and DHS with polymethylmethacrylate (PMMA) augmentation shows satisfactory long-term result,and it is worthy of further clinical application and research.

关 键 词：骨纤维发育不良 股骨 髋内翻 

分 类 号：R684.2[医药卫生—骨科学]