股骨近段纤维结构不良内翻畸形的手术疗效

目的 评估和分析股骨近段纤维结构不良内翻畸形手术治疗的临床疗效.方法 2000年8月至2009年5月,采用截骨矫形、病灶刮除、打压植骨、股骨重建钉内固定治疗21例(24个)股骨纤维结构不良伴重度内翻畸形患者,男12例,女9例;年龄14～39岁,平均22.7岁.其中15例为单纯髋内翻畸形,6例同时伴髋内翻及股骨内翻畸形.颈干角55°～105°,平均75°;股骨内翻角18°～45°,平均30°;患侧股骨长度较对侧短缩2.0～4.5 cm,平均3.4cm.其中13例患者因发生病理性骨折而行手术治疗.结果 21例患者均获得随访,随访时间21个月至7年,平均3年4个月.24个股骨共30处截骨面中,28处于术后3～6个月骨性愈合,2例双段远端截骨面各有1处在术后12个月时仍不愈合,经再次植骨3个月后骨性愈合.21例内翻畸形股骨力线均完全矫正,术后颈干角矫正为95°～135°,平均118°;股骨内翻角完全纠正.股骨长度较术前延长1.8～3.6 cm,平均2.8cm.术后无一例患者发生感染、畸形进展及再骨折.17例患者疼痛视觉模拟评分(visual analogue scales,VAS)由术前7～10分降至术后0分,4例VAS评分由术前8～10分降至术后3～4分.Harris髋关节功能评分优12例,良6例,可3例.结论 外翻截骨可有效矫正内翻畸形,股骨重建钉可稳定股骨,大量打压式植骨可有效恢复骨量.

Abstract：

Objective To evaluate and analyse the effectiveness of surgical treatment for fibrous dysplasia in proximal femur with severe varus deformity.Methods A retrospective study was performed in 21 patients (24 femora)of fibrous dysplasia who were treated in our hospital between August 2000 and May 2009.All patients had severe femoral varus deformity.The four-step procedures were performed orderlv as valgus osteotomy,lesion curettage,impacting of massive bone allograft,and fixation by femoral intramedullary nail.There were 6 patients with monostotic disease,15 with polyostotic diseases,including 12 males and 9 females with a mean age of 22.7 years(range,14-39 years).The average neck-shaft angle and femoral varus angle was 75°(range 55°-105°)and 30°(range,18°-45°),respectively.The average length of thigh shortened 3.4 cm(range,2.0-4.5 cm)compared with the contralateral thigh.Results All of the 21 patients were followed up from 21 months to 7 years with an average period of 3 years and 4 months.There were 30 osteotomy sites in 24 femurs,28 osteotomy sites showed bone union after 3-6 months from surgery.Two distal location of the double-level osteotomy showed nonunion,which received bone grafting again and got bone union after 3 months finally.The femoral mechanical alignments of the 21 patients had been recriticd.The average neck-shaft angle was 118°(range,95°-135°)postoperatively,the femoral varus angle disappeared.The average extremity lengthening was 2.8 cm(range,1.8-3.6 cm)postoperatively.There were no infection,recurrent fracture and progression of deformity.The visual analogue scales(VAS)score of 17 patients decreased to zero postoperatively from 7-10 preoperatively,and that of the other 4 patients decreased to 3-4 postoperatively from 8-10 preoperatively.The result of Harris hip functional score was excellent in 12 cases,good in 6,and fair in 3.Conclusion The valgus osteotomy can rectify varus deformity effectively.The reconstract nail of the fumer can support the stability of femur.Impacting of massive bone allograft can improve the capacity of the femur.     

Treatment of ipsilateral femoral neck and shaft fractures

Objective：To investigate the clinical characteristics, treatment options and causes of misdiagnosis of ipsilateral femoral neck and shaft fractures.
Methods： Among 20 patients with ipsilateral femoral neck and shaft fractures, 19 were treated operatively and 1 was treated conservatively. Sixteen cases of femoral shaft fractures were treated by open reduction and internal fixation with compressive plate, and 2 cases were treated with interlocking intramedullary nailing. Eighteen femoral neck fractures were treated with cannulated screws. Another patient was treated with proximal femoral nail to fix both the neck and shaft. Delayed diagnosis for femoral neck frac-tures occurred in 2 cases preoperatively. Results： A total of 19 patients were followed up. The follow up period ranged from 5 to 48 months with an average of 15 months. All the fractures were healed.
Conclusion： For case of femoral shaft fracture caused by high energy injury, an AP pelvic film should be routinely taken. Once the femoral neck fracture is recognized, operative reduction and fixation should be performed in time. Femoral neck and shaft fractures should be fixed separately.     

提高股骨干骨折合并同侧股骨颈骨折早期诊断率的前瞻性研究

Objective To evaluate a serf-designed diagnostic protoeol which can early detect a femoral neck fracture for patients with a femoral shaft fracture. Methods From September 2005 to June 2007, a self-developed protocol was used to detect an ipsilateral femoral neck fracture for all the patients with femoral shaft fracture who had sought treatment in our department. This protocol consisted of anteroposterior plain radiography of internal rotator, intraoperative fluoroscopy of the hip, a fine (2 mm) cut computed to-mographic scan through the femoral neck, postoperative anteroposterior and lateral plain radiography of the hip in the operating room prior to awakening the patient, at the time of follow-up anteroposterior and lateral plain radiography of the hip in the presence of hip pain. The diagnostic effects of the protocol were compared with those of conventional diagnosis used for all the patients with femoral shaft fracture who had sought treatment in our department from September 2003 to August 2005. A chi-square analysis comparing the protocol group (September 2005 to June 2007) and the non-protocol group (September 2003 to August 2005) was used to assess the early and delayed diagnosis rates for an associated ipsilateral femoral neck fracture. Results The earlydiagnosis rate of an associated femoral neck fracture by the protocol was 93.8%, markedly higher than that by conventional method (46.2%), with statistically significant difference (χ2 = 4.069, P =0.044). Conclu-sion In presence of a femoral shaft fracture. this protocol consisting of plain radiography of intemal rotator, intraoperative fluoroscopy of the hip, fine cut computed tomographic scan of the femoral neck, postoperative plain radiography of the hip, and follow-up plain radiography of the hip in the presence of hip pain, may sig-nificantly improve the diagnostic rate of an associated femoral neck fracture.     

提高股骨干骨折合并同侧股骨颈骨折早期诊断率的前瞻性研究

Objective To evaluate a serf-designed diagnostic protoeol which can early detect a femoral neck fracture for patients with a femoral shaft fracture. Methods From September 2005 to June 2007, a self-developed protocol was used to detect an ipsilateral femoral neck fracture for all the patients with femoral shaft fracture who had sought treatment in our department. This protocol consisted of anteroposterior plain radiography of internal rotator, intraoperative fluoroscopy of the hip, a fine (2 mm) cut computed to-mographic scan through the femoral neck, postoperative anteroposterior and lateral plain radiography of the hip in the operating room prior to awakening the patient, at the time of follow-up anteroposterior and lateral plain radiography of the hip in the presence of hip pain. The diagnostic effects of the protocol were compared with those of conventional diagnosis used for all the patients with femoral shaft fracture who had sought treatment in our department from September 2003 to August 2005. A chi-square analysis comparing the protocol group (September 2005 to June 2007) and the non-protocol group (September 2003 to August 2005) was used to assess the early and delayed diagnosis rates for an associated ipsilateral femoral neck fracture. Results The earlydiagnosis rate of an associated femoral neck fracture by the protocol was 93.8%, markedly higher than that by conventional method (46.2%), with statistically significant difference (χ2 = 4.069, P =0.044). Conclu-sion In presence of a femoral shaft fracture. this protocol consisting of plain radiography of intemal rotator, intraoperative fluoroscopy of the hip, fine cut computed tomographic scan of the femoral neck, postoperative plain radiography of the hip, and follow-up plain radiography of the hip in the presence of hip pain, may sig-nificantly improve the diagnostic rate of an associated femoral neck fracture.     

提高股骨干骨折合并同侧股骨颈骨折早期诊断率的前瞻性研究

Objective To evaluate a serf-designed diagnostic protoeol which can early detect a femoral neck fracture for patients with a femoral shaft fracture. Methods From September 2005 to June 2007, a self-developed protocol was used to detect an ipsilateral femoral neck fracture for all the patients with femoral shaft fracture who had sought treatment in our department. This protocol consisted of anteroposterior plain radiography of internal rotator, intraoperative fluoroscopy of the hip, a fine (2 mm) cut computed to-mographic scan through the femoral neck, postoperative anteroposterior and lateral plain radiography of the hip in the operating room prior to awakening the patient, at the time of follow-up anteroposterior and lateral plain radiography of the hip in the presence of hip pain. The diagnostic effects of the protocol were compared with those of conventional diagnosis used for all the patients with femoral shaft fracture who had sought treatment in our department from September 2003 to August 2005. A chi-square analysis comparing the protocol group (September 2005 to June 2007) and the non-protocol group (September 2003 to August 2005) was used to assess the early and delayed diagnosis rates for an associated ipsilateral femoral neck fracture. Results The earlydiagnosis rate of an associated femoral neck fracture by the protocol was 93.8%, markedly higher than that by conventional method (46.2%), with statistically significant difference (χ2 = 4.069, P =0.044). Conclu-sion In presence of a femoral shaft fracture. this protocol consisting of plain radiography of intemal rotator, intraoperative fluoroscopy of the hip, fine cut computed tomographic scan of the femoral neck, postoperative plain radiography of the hip, and follow-up plain radiography of the hip in the presence of hip pain, may sig-nificantly improve the diagnostic rate of an associated femoral neck fracture.     

Free iliac crest grafts with periosteum for treatment of old acetabular defects

Objective: To inquire into the therapeutic effectiveness of free iliac crest grafts with periosteum on old acetabular defects. Methods:From February 1996 to June 2005, 9 patients were treated with free iliac crest grafts with periosteum to reconstruct old acetabular defects. There were 7 males and 2 females and the average age was 41.3 years. The acetabular defects were caused by traffic accidents in 6 cases and fall injury in 3 cases. The time from injury to treatment was 4-13 months and averaged 8 months. Intraoperatively we firstly removed the acetabular fracture fragments of the posterior wall. The femoral head was then reducted. Bone graft was harvested from the iliac crest with periosteum,which was sculpted with a rongeur to conform to the defect. The concave (iliac fossa) side of the graft was placed toward the femoral head. The graft was securedly fixed by two to three leg screws. Results:Postoperative syndrome was not found in any of the cases. Harris' score system showed that the score raised from 32. 3 points preoperatively to 81 points postoperatively. The hip function was evaluated as excellent in 3 cases,good in 4 cases and fair in 2 cases. Conclusions: Although this procedure could not exactly reproduce the anatomy of the hip joint, it enables to restore the posterior stability, provide bone-stock for the hip joints and prevent dislocation of the femoral head.     

前外侧和外侧联合入路的股骨颈肿瘤刮除植骨及内固定术

目的 探讨前外侧和外侧联合入路肿瘤刮除植骨重建治疗股骨颈骨肿瘤的疗效.方法 2005年7月至2009年8月采用前外侧和外侧联合入路手术治疗股骨颈肿瘤12例,男7例,女5例;年龄1768岁,平均34岁.软骨母细胞瘤4例,原发性骨巨细胞瘤2例,纤维结构不良3例,骨囊肿3例.7例有病理性骨折,5例骨皮质变薄.按国际保肢协会股骨颈肿瘤分区H1区1例、H2区4例、H1,2区7例.前外侧Smith-Peterson入路行肿瘤刮除植骨,外侧Watson-Jones入路行内固定.内固定采用解剖钢板10例,经皮空心螺钉2例.结果 全部患者随访12～68个月,平均35个月.患者疼痛均消失,随访期间无复发,无病理性骨折、股骨头坏死、关节退变.1例出现股骨外侧皮肤麻木,术后6个月自行缓解;1例出现外展无力.11例恢复正常活动范围,前屈120°～135°,后伸9°～15°,外展30°～45°.国际骨与软组织肿瘤协会功能评分27～30分,平均29.2分.结论 前外侧"SP"入路可以充分暴露肿瘤部位,手术视野清晰,刮除彻底,复发率低;外侧"WJ"入路易于植入内固定,防止术后病理性骨折的发生.股骨颈骨折采用前外侧"SP"与外侧"WJ"联合入路肿瘤刮除植骨重建的近期疗效较好.

Abstract：

Objective To explore surgical procedure of combined anterior-lateral and lateral approach for the treatment of bone tumors of femoral neck. Methods Forty patients with bone tumors of femoral neck treated in Tianjin Hospital were included from July 2005 to August 2009. Of the patients, 12 who were treated with curettage and bone graft through combined anterior-lateral and lateral incision were analyzed in this study. There were 7 males and 5 females with an average age of 34 years ranging from 17 to 68 years. 4 patients were diagnosed as chondroblastoma, 2 giant cell tumor, 3 fibrous dysplasia, and 3 single bone cysts. 7 patients suffered from pathologic fractures, and 5 had presented thin cortical bone because of tumor involvement. There were 1 tumor located in H1 zone, 4 in H2 zone and 7 in H1,2 zone according to ISOLS femoral neck classification. All patients were treated by curettage and bone graft via anterior-lateral approach, 10 cases underwent internal fixation with anatomical plate, and 2 cases with canulated screws with lateral approach. Results The follow-up time ranged from 10 to 68 months with an average of 35 months.Pain disappeared in all patients, and there were not recurrence of tumor, pathologic fractures and avascular necrosis. One case had complained of lateral femoral skin numbness which may be caused by injures of femoral lateral nerves. One case had difficulties in the valgus of hip joint. The mean MSTS score was 29.2 points ranging from 27 to 30 points. Conclusion Anterior approaches of "SP" incision is helpful to thorough curettage which decrease the risk of recurrence due to good visualization and intemal fixation is easy to perform via lateral approaches. The result suggested that combined anterior-lateral "SP" and lateral incision is liable option in treatment of bone tumors of femoral neck.     

防旋股骨近端髓内钉治疗老年不稳定型股骨转子间骨折

Objective To evaluate the clinical effects of proximal femoral nail anti-rotation (PFNA) in treating femoral intertrochanteric fractures in the aged patients. Methods Under the guidance of flu-oroscopy, closed reduction, minimally invasive incision and percutaneous PFNA fixation were applied to treat 41 old patients with femoral intertrochanteric fracture from June 2006 to August 2008 in our hospital. They were 12 males and 29 females, with an average age of 74. 3 (67 to 92 years) years. According to Evans-Jensen classi-fication, there were 11 cases of ⅡA, 24 ⅡB, and 6 Ⅲ. Postoperative hip functions were evaluated by Harris system. Results The patients were followed up for 17.2 (6 to 31) months averagely. Fracture union was achieved in all patients with a mean healing time of 12. 5 (10 to 17) weeks. The postoperative Harris score was excellent in 26 cases, good in 13 and fair in 2. The total excellent to good rate was 95.1%. No in-fection, coxa vara, external rotation or shortening deformity, cut-out, fracture of femoral shaft, internal fix-ation failure or bone nonunion occurred. Conclusion Since PFNA fixation has advantages of less inter-ference with blood circulation at the fracture ends, little osseous destruction, simple operation, limited inva-sion, less blood loss, anti-rotation, stable fixation and few postoperative complications, it is an effective treatment for femoral intcrtrochanteric fractures in senile patients.     

Preliminary effect of proximal femoral nail antirotation on emergency treatment of senile patients with intertrochanteric fracture

Objective： To retrospectively analyse the clinical outcome of emergency treatment of senile intertrochanteric fractures with proximal femoral nail antirotation （PFNA）.
Methods： From September 2008 to March 2009, 35 senile patients with intertrochanteric fracture, aged from 65 to 92 years with an average age of 76.5 years, were treated with PFNA within 24 hours after injury. There were 10 type Ⅰ fractures, 19 type Ⅱand 6 type Ⅲ according to upgraded Evans-Jensen classification system. All patients were complicated with osteoporosis, and 19 patients had preexisting internal medical diseases. According to the rating scale of disease severity by the American Society of Anesthesiologists （ASA）, there were 9 grade Ⅰ, 14 grade Ⅱ, 8 grade Ⅲ, and 4 grade Ⅳ.
Results： The duration for operation ranged from 45 to 73 minutes with an average of 57.6 minutes. The volume of blood loss during operation ranged from 50 to 120 ml with an average of 77.5 ml. Patients could ambulate 2-4 days after operation （mean 3.5 days）. Hospital stay was 4-7 days （mean 5.3 days）. Full weight bearing time was 10-14 weeks （mean 12.8 weeks）. During hospitalization period, there was no regional or deep infection, hypostatic pneumonia, urinary tract infection and bedsore except for 2 cases of urine retention. All cases were followed up with an average period of 12.3 months, and bone healing achieved within 15-18 weeks （mean 16.6 weeks）. No complications such as delayed union, coxa vara or coxa valga, screw breakage or backout occurred and only 2 cases had troehanter bursitis because of thin body and overlong end of the antirotated nail. According to the Harris grading scale, the results were defined as excellent in 21 cases, good in 9 cases and fair in 5 cases, with the excellent and good rates of 85.7%.
Conclusion： The emergency treatment of senile intertrochanteric fracture with proximal femoral nail antirotation has the advantages of minimal invasion, easy manipulation, less blood loss, shorter length of stay, less complications, and the preliminary clinical effect is satisfactory.     

应用单边外固定支架矫正胫骨近端内翻畸形

目的 探讨应用单边外固定支架矫正胫骨近端内翻畸形的疗效.方法 2004年7月至2010年8月应用单边外固定支架治疗5例胫骨近端内翻畸形患者,男2例,女3例;年龄18～42岁,平均32岁.胫骨平台骨折与胫骨近端骨折畸形愈合各2例,胫骨近端截骨延长后出现牵开骨痂的畸形愈合1例.术中对腓骨进行截骨,在胫骨安装外固定支架,并在胫骨近端进行截骨.术后7～10 d通过外固定支架逐渐牵开并纠正成角畸形.结果 所有患者术后获5～11个月(平均8.4个月)随访.1例患者牵开处不愈合,经植骨治疗后愈合;其余4例均愈合,愈合时间为3～6个月,平均4.8个月,带架时间为4～8个月,平均6.8个月.所有腓骨截骨端均愈合,针道除并发轻微反应外无严重并发症,手术与矫正过程中未出现神经损伤等并发症.机械轴偏向矫正后较健侧平均外移8 mm(1～13mm).胫骨近端内侧角矫正后平均为90°(87°～92°).矫正后患侧肢体和健侧差异为-6～1 mm,胫骨和健侧长度差异为-2～3 mm.结论 单边外固定支架能够成功矫正胫骨近端内翻畸形愈合,与传统的外翻截骨内同定相比,它具有创伤小、无需植骨及截骨方法简单的优点,逐渐矫正能获得更准确的力线,同时可矫正肢体短缩、避免再次手术.

Abstract：

Objective To review gradual correction of proximal tibial varus malunion with a unilateral external fixator for osteogenetic distraction. Methods From July 2004 to August 2010, we treated 5 cases of proximal tibial varus malunion with a unilateral external fixator. They were 2 men and 3 women,with an average age of 32 years (from 18 to 42 years). Two cases were malunion after tibial plateau fracture,2 after proximal tibial fracture, and one after osteogenetic distraction. After fibular osteotomy, a tibial unilateral external fixator was installed before proximal tibial osteotomy. Varus was corrected for 7 to 10 days after surgery by gradual distraction till the same alignment was obtained as the contralateral side. The external fixator was not removed until consolidation and full weight bearing. Results The follow-ups ranged from 5 to 11 months (average, 8. 4 months). Four cases got united after 3 to 6 months (average, 4. 8 months).Time for external fixator ranged from 4 to 8 months (average, 6. 8 months) . One case obtained bone union after bone grafting. All fibulas healed after osteotomy. No other complications were present except mild pin-tract problems. Compared with the contralateral side, the corrected malalignment deviation was laterally displaced by 8 mm on average (from 1 to 13 mm), the corrected medial proximal tibial angle was 90° on average (from 87° to 92°), the limb length discrepancy was -6 to 1 mm, and the tibial length discrepancy was - 2 to 3 mm. Conclusions Proximal tibial varus malunion can be corrected gradually and effectively by a unilateral external fixator. Its advantages over valgus osteotomy and internal fixation are less invasion due to simple transverse osteotomy, accurate correction not only of angulation but also of length discrepancy, and no need of bone grafting or implant removal.     

The reciprocal ledge closing wedge osteotomy for post traumatic coxa vara

To report a proximal femoral osteotomy with retention of bone ledges in a reciprocal position to increase bone contact and stability. The method was applied to 5 patients over a 3-year period. All patients had coxa vara. The average length gained was 1.5 cm, and the average neck shaft angle improvement was 30°. The Harris hip score improved from an average of 63 to 82. The reciprocal ledge osteotomy is technically less demanding and also allows conversion of normal shear forces around the upper femur to stabilizing forces. This method allows easier use of the DHS implant as potential rotation about the axis of the screw is negated by the ledges and the dynamic forces.     

Multiple osteotomies and intramedullary nailing with neck cross-pinning for shepherd's crook deformity in polyostotic fibrous dysplasia: 7 femurs with a minimum of 2 years follow-up

Background In polyostotic fibrous dysplasia, particularly in lesions of the proximal femur, pathological fracture and coxa vara deformity (including shepherd's crook deformity) are likely to develop and progress.

Patients and methods In 7 femurs with shepherd's crook deformity (5 patients), we performed intramedullary nailing by using multiple osteotomies and two screws crossing the femoral neck.

Results Restoration of the neck shaft angle of the femur was obtained from an average of 92° prior to surgery to 129° after surgery. During the minimum 2-year follow up, no loss of neck shaft angle of the femur and no refracture occurred. All patients were able to return to normal activities of daily living.

Interpretation In polyostotic fibrous dysplasia, multiple osteotomies and intramedullary nailing with neck cross-pinning can be used to correct developed or progressing shepherd's crook deformity, and to prevent recurrence and refracture.     

股骨干骨折合并同侧股骨颈骨折治疗的临床观察

目的：探讨股骨干合并同侧股骨颈骨折的治疗特点和不同固定方法的疗效。方法：股骨干骨折合并同侧股骨颈骨折27例,男22例,女5例;年龄14～65岁,平均35岁。动力髋螺钉（DHS）固定3例,加压钢板加空心加压螺钉固定12例,重建钉固定8例,顺行髓内钉加空心加压螺钉固定4例。13例固定术前用克氏针临时固定股骨颈骨折。结果：术后随访36～75个月,平均44个月。25例股骨颈骨折平均愈合时间4.5个月,2例股骨颈骨折不愈合。27例股骨干均愈合,平均愈合时间6个月。未用克氏针临时固定股骨颈骨折14例中,2例出现股骨颈不愈合,3例轻度髋内翻畸形。结论：股骨干合并同侧股骨颈骨折有许多固定方法可供选择,加压钢板加空心加压螺钉固定简便易用,在实施固定术前用克氏针临时固定股骨颈骨折可避免股骨颈骨折再移位和损伤。     

Multiple osteotomies and intramedullary nailing with neck cross-pinning for shepherd's crook deformity in polyostotic fibrous dysplasia: 7 femurs with a minimum of 2 years follow-up

Background?In polyostotic fibrous dysplasia, particularly in lesions of the proximal femur, pathological fracture and coxa vara deformity (including shepherd's crook deformity) are likely to develop and progress.

Patients and methods?In 7 femurs with shepherd's crook deformity (5 patients), we performed intramedullary nailing by using multiple osteotomies and two screws crossing the femoral neck.

Results?Restoration of the neck shaft angle of the femur was obtained from an average of 92° prior to surgery to 129° after surgery. During the minimum 2-year follow up, no loss of neck shaft angle of the femur and no refracture occurred. All patients were able to return to normal activities of daily living.

Interpretation?In polyostotic fibrous dysplasia, multiple osteotomies and intramedullary nailing with neck cross-pinning can be used to correct developed or progressing shepherd's crook deformity, and to prevent recurrence and refracture.     

股骨转子间杵臼状外展截骨术治疗儿童髋内翻

本文报告采用股骨转子间杵臼状外展截骨术治疗儿童髋内翻１０例（１４髋）。年龄为６～１２岁。截骨处均在８周愈合。８例（１２髋）随访３～１０年（平均４年２月），均取得满意疗效。作者认为，本术式方法简单，截骨处接触面大，截骨后稳定，愈合快，畸形矫正满意，疗效好。对股骨颈干角小于１１０°者均可采用本法矫正，较大儿童颈干角应矫正至１３５°～１４５°。截骨后应以钢板螺丝钉内固定，并用髋人字石膏固定６～８周。     

动力髋螺钉治疗股骨转子周围骨折

目的：探讨动力髋螺钉（DHS）治疗股骨转子周围骨折的疗效及所致并发症的原因。方法：1999年1月-2004年1月共收治股骨转子周围骨折112例，其中男58例，女54例；年龄36～94岁，平均67．2岁。采用DHS内固定103例，DHS结合骨水泥固定3例，DHS结合大转子稳定钢板（TSP）内固定6例，回顾性分析其治疗效果及并发症发生的原因。结果：94例获得5～18个月随访，平均11个月，所有患者均获得骨性愈合。按黄公怡疗效评定标准：优33例，良52例，可5例，差4例，优良率90．4％。术后局部并发症有骨折延迟愈合1例，髋内翻3例，螺钉从股骨头割出3例。结论：DHS是治疗股骨转子周围骨折的有效手段，适应证的正确选择和内固定物的正确置入是提高疗效、减少并发症的关键。     

Fibular osteosynthesis for delayed type II and type III femoral neck fractures in children.

Seventeen transcervical/basal femoral neck fractures in children were treated by free fibular graft and cancellous lag screw. Two cases were failures of a previous surgery, and 15 had been untreated for 3 weeks or more. Four cases had radiological evidence of avascular necrosis of the head and one of the neck preoperatively; five cases had neck resorption. At an average of 48.1 months postsurgery all fractures had united and there was only one new case of avascular necrosis. Four cases had coxa vara, and four cases had premature epiphyseal closure. There were 13 good, three fair, and one poor result(s) using Ratliff's criteria. We recommend this procedure in cases with delayed initial appearance or failed previous surgery. Complications of the procedure such as long screw/graft and fibular fracture are preventable. The incidence of coxa vara in cases with neck resorption may be reduced by adding subtrochanteric osteotomy to the procedure.     

Monostotic fibrous dysplasia in the femoral neck. A clinicopathologic study

In eight patients with monostotic fibrous dysplasia in the femoral neck, the lesion was virtually limited to the neck region without any extension into the shaft. In one patient with symptoms of 40 years' duration and another with a recurrent lesion, there was a deformity in the neck of the femur. A pathologic fracture, including a minor one, was identified in two patients. Roentgenographically, the lesion should be distinguished from various entities producing a localized central region of rarefaction in the proximal femur. The histologic features of fibrous dysplasia are characteristically diagnostic. Six of the eight patients were successfully treated by curettage and bone graft. There was no evidence of malignant transformation.     

Valgus osteotomy in combination with dynamic hip screw fixation for fibrous dysplasia with shepherd’s crook deformity

Background and objectives

The treatment of fibrous dysplasia with shepherd’s crook deformity is a big challenge. The purpose of this study was to investigate the clinical effect of valgus osteotomy in combination with dynamic hip screw (DHS) fixation to treat fibrous dysplasia with shepherd’s crook deformity.

Method

Twenty-one clinical cases of femoral fibrous dysplasia with shepherd’s crook deformity treated between April 2001 and May 2010 were retrospectively analyzed. The valgus osteotomy and internal fixation were performed for these patients. Six patients underwent DHS and trochanter stabilizing plate internal fixation, and the other 15 cases were stabilized by DHS fixation.

Results

Patients were followed for 19–128 months. The neck-shaft angle was corrected from 89° (range 65°–107°) preoperatively to 129° (range 119°–140°) postoperatively. Limb-length discrepancy was corrected from 3.0 (range 1.8–4.5) cm preoperatively to 0.7 (range 0–1.9) cm postoperatively. All osteotomies had healed at the final follow-up examination. The clinical scores, which were evaluated by the modified criteria of Guille, improved from an average of 2.9 (range 1–7) to 8.5 (range 6–10).

Conclusion

Our results demonstrate that valgus osteotomy in combination with DHS internal fixation is an easy and effective method for the treatment of fibrous dysplasia with shepherd’s crook deformity. It can restore the neck-shaft angle and re-establish the mechanical alignment of the femur to improve function.