病灶清除、植骨联合内固定治疗下肢长管状骨纤维结构不良的疗效和并发症观察

背景：骨纤维结构不良临床上可表现为单发或多发的骨骼畸形、疼痛和病理性骨折。目前该病的治疗方法以手术清除病灶、植骨内固定为主。目的：探讨病灶清除、植骨联合髓外固定治疗下肢长管状骨纤维结构不良的疗效和可行性。方法方法：选取2010年2月至2012年11月我院收治的15例骨纤维结构不良患者的病例资料进行回顾性分析,男8例,女7例;年龄26-48岁,平均（32.1±1.2）岁;股骨9例,胫骨6例。均采用病灶清除,取髂骨植骨,动力髋螺钉或锁定接骨板固定。围手术期予抗炎、补液对症处理,术后石膏固定,指导患者功能锻炼。髋关节功能按Harris评分系统评定。膝关节功能按Merchan评分系统评定。术后定期摄X线片,观察肿瘤复发情况,植骨融合情况和不良反应发生情况。结果：所有伤口均甲级愈合,按期拆线。所有患者均完成18个月随访,无1例复发,植骨均融合,术后部分负重下地时间（4.3±0.6）个月,X线片未见骨溶解,术后（4.0±0.8）个月可见新生骨长入,2例患者残留手术区疼痛,对症治疗后缓解。术后髋关节功能Harris评分为97.2分,膝关节功能Merchan评分为95.8分,均较术前显著提高（P〈0.05）。结论：病灶清除、植骨联合髓外固定在下肢长管状骨纤维结构不良患者中固定可靠,预后佳,是一种可行的治疗方法。

Efficacy and complications of debridement combined with bone grafting and internal fixation for fibrous dysplasia of long bone of lower limb

Background： Main clinical manifestations of bone fibrous dysplasia are single or multiple skeletal deformity, pain and pathological fracture. The popular treatment therapy is debridement combined with bone grafting and internal fixation.Objective： To investigate the efficacy and feasibility of debridement combined with bone grafting and extramedullary fixation in the treatment of lower limb long bone of fibrous dysplasia.Methods： Clinical data of 15 patients with bone fibrous dysplasia treated between February 2010 and November 2012 in our hospital were analyzed retrospectively. There were 8 males and 7 females with an average age of（32.1±1.2） years（range,26-48 years）. The femur was affected in 9 cases and the tibia was affected in 6 cases. All the patients were treated by debridement, iliac bone grafting, dynamic hip screws or locking plate fixation. Perioperative anti-inflammatory and fluid infusion and postoperative plaster external fixation were applied. Harris score and Merchan score were used to assess the function of hip and knee joints, respectively. Recurrence, bone fusion and adverse reaction were observed during follow-up.Results： Primary healing was achieved in all incisions. All the patients were followed up at least 18 months. No recurrence or osteolysis was found, and bone grafts were completely fused. Postoperative walking with partial weight-bearing began at（4.3±0.6） months after treatment. Newly formed bone was seen by X films（4±0.8） months postoperatively. There were 2 patients suffering from pain at operating field, which alleviated after symptomatic treatment. The Harris score of hip function was 97.2 and Merchan score of knee function was 95.8 after operation, which were significantly higher than preoperative ones（P〈0.05）.Conclusions： Debridement combined with bone grafting and extramedullary fixation is a feasible treatment method for the fibrous dysplasia of lower limb long bone