股骨近端骨纤维结构不良伴髋内翻畸形的髓内固定疗效

背景：股骨近端骨纤维结构不良伴髋内翻畸形必须进行外科矫形治疗，尽量恢复股骨正常的生物力线。目前尽管截骨矫形方案很多，但楔形外翻截骨已成主流，矫形后单纯外固定并发症较多，螺钉、钉一板系统等髓外固定存在问题较多，难以获得长期稳定的治疗效果，有研究表明，股骨近端处楔形外翻截骨、交锁髓内针内固定可获得较好的中长期治疗效果。目的：观察股骨近端骨纤维结构不良伴髋内翻畸形的懿内固定的治疗方法及生物相容性。方法：纳入23例股骨近端髋内翻伴肢体短缩畸形的股骨近端骨纤维结构不良患者，颈干角为56°-110°，平均79°，股骨相对长度较对侧短缩1．9-8．9cm，平均4．0cm。所有患者均行股骨近端处楔形外翻截骨、病灶清除、取肋骨植骨、交锁髓内钉内固定。结果与结论：固定后19例获得随访，随访时间6个月至2年，平均1年。所有内固定物均牢靠。股骨生物力线均基本矫正，截骨面处达骨性愈合，髋内翻畸形的颈干角矫正为90°-125°，平均112°，股骨相对长度矫正后较固定前延长1．5-2．5cm，平均2．0cm，所有患者髋关节功能影响不明显。固定后19例患者中3例正常行走无跛行，7例扶双拐行走，5例扶单拐行走，4例不扶拐轻度跛行。固定后19例患者中12例疼痛消失，6例疼痛明显缓解，加重并出现新疼痛1例。所有患者固定后均无感染、再骨折及畸形进展。结果证实，股骨近端处楔形外翻截骨、病灶清除、取肋骨植骨、交锁髓内钉内固定治疗股骨近端髋内翻伴肢体短缩畸形的股骨近端骨纤维结构不良效果良好，不仅可减少植骨量、充分矫正畸形及预防复发，而且中期随访观察证实截骨面处达到骨性愈合，髋关节功能改善良好，生物相容性较好。

Intramedullary internal fixation for the treatment of fibrous dysplasia of proximal femur combined with coxa varus deformity

BACKGROUND： The surgical treatment for fibrous dysplasia of the proximal femur combined with coxa varus deformity must be carried out in order to restore the mechanical axis of the femur as far as possible. Though, there are various osteotomy programs, wedging valgus osteotomy has predominated. There are more complications after extramedullary fixation, such as screws and screw-plate systems, and the long-term stable therapeutic effect cannot be reached. Studies have shown that the wedging valgus osteotomy at the proximal femur and interlocking intramedullary nail fixation can obtain better medium- and long-term therapeutic effect. OBJECTIVE： To investigate the intramedullary internal fixation method for the treatment of fibrous dysplasia of proximal femur combined with coxa varus deformity, and to investigate the biocompatibility. METHODS： A total of 23 patients with fibrous dysplasia of proximal femur combined with coxa varus and limb reduction deformities were adopted and treated. The mean femoral neck-shaft angle was 79° in average （range 56°-110°）. The relative femoral length was 4.0 cm shorter on average （range 1.9-8.9 cm） than that of the opposite side. All patients were treated with wedging valgus osteotomy in the proximal femur, curettage, autogenous rib bone-grafting and interlocking intramedullary nail internal fixation. RESULTS AND CONCLUSION： Postoperatively, 19 patients were followed-up for an average period of I year （range 6 months to 2 years）. All internal fixations were stable. The mechanical axis of femur was just corrected, all patients got bone healing. Postoperative neck-shaft angle was corrected to 112°on average （range 90°-125°） and the average relative length of femur was increased by 2.0 cm on average （range 1.5-2.5 cm）, and there was no significant effect on hip function. After surgery, three patients could walk normally without claudication, seven patients could walk with crutches, five patients ambulated with a unilateral cane and four patients were slightly limbing without support. Pain disappeared in 12 patients, pain was significantly improved in six patients, and pain aggravated and new pain appeared in one patient. No infection, refracture or progression of deformity occurred in the patients. The surgical treatment method of wedging valgus osteotomy in the proximal femur, curettaging, autogenous rib bone-grafting and interlocking intramedullary nail internal fixation have good effect for fibrous dysplasia of proximal femur combined with coxa varus and limb reduction deformity. This method can not only reduce the mass of bone-grafting and fully correct deformity, but also can prevent recurrence of the deformity. And meanwhile, the middle-term follow-up observation confirms that the osteotomy surface get bone healing, and hip function is significantly improved with good biocompatibility.