新方法治疗长骨骨化性纤维瘤刮除术后骨缺损

目的：介绍一种长骨骨化性纤维瘤刮除术后骨缺损修复的新方法，并总结其治疗效果。方法：对3例长青骨化性纤维瘤，在经手术彻底刮除病灶后所形成的包容性骨缺损的血肿内，植入自体骨膜碎片，通过术前，术手影像学对比和临床功能进行评价，结果：经3－6年随访，X线处显示成骨良好，骨缺损修复，病变未复发，肢体功能正常。结论：长骨骨化性纤维瘤属良性肿瘤，发病率较低，术前易误诊，术后易复发。病灶彻底刮除，在骨缺损区血肿内植入自体骨膜碎片，是治疗骨化性纤维瘤的有效新方法。     

长骨的非骨化性纤维瘤9例报告

非骨化性纤维瘤（Ｎｏｎｏｓｉｆｙｉｎｇｆｉｂｒｏｍａ）是一种纤维组织所构成的良性肿瘤〔１〕,临床上不多见〔２～４〕,对该肿瘤的本质尚有争论。作者于１９８８年６月～１９９７年１月共收治经临床病理确诊的非骨化性纤维瘤９例,其中２例呈多发性,国内仅见１例...     

长骨多发性骨化性纤维瘤一例报告

长骨多发性骨化性纤维瘤一例报告张华俦黄建发黄公怡患者男，５７岁。因外伤摄右髋部及右小腿正侧位片偶然发现右股骨颈及右胫骨中下段骨结构异常，于１９９５年６月１４日收治入院。查体示右髋部及右小腿无红肿，无静脉怒张，触之局部皮温不高，局部有轻压痛，右髋关节及...     

长骨骨化性纤维瘤（附7例报告）

长骨骨化性纤维瘤（附７例报告）刘晓平，于秀淳骨化性纤维瘤（ＯｓｓｉｆｙｉｎｇｆｉｂｒｏｍａＯＦ）多发于颌骨，发生于长骨者较少见。本文将我院１９７２年至１９９４年１２月收治的７例ＯＦ的临床资料结合文献加以讨论。１临床资料本组女６例，男１例，年龄平均１４...     

非骨化性纤维瘤的诊断与治疗

目的：探讨非骨化性纤维瘤的本质和属性、临床特点及诊治方法。方法：总结１９９３～１９９９年收治的非骨化性纤维瘤２４例。其中男１６例，女８例，平均１５．６岁。多发性２例，合并其他良性肿瘤２例。病灶多发生于四肢长骨的干骺端，以膝关节周转最常见。全部病例均行手术治疗，术式包括单纯病灶刮除术、病灶刮除自体髂骨或加异体骨移植术。结果：全部病例均经病理证实为非骨化性纤维瘤，随访最长６ａ ３个月，无一例复发。结论     

非骨化性纤维瘤的临床诊断与治疗

目的探讨非骨化性纤维瘤的临床特点、影像学特征及手术疗效。方法回顾分析2000年1月至2006年4月收治的15例非骨化性纤维瘤患者的临床表现及影像学特征并评价手术疗效。结果13例患者得到随访,平均随访时间6.2个月,病灶处骨性愈合者9例,不完全骨性愈合者4例(股骨2例,胫骨2例)。4例不完全骨性愈合患肢均能完全负重,邻近关节活动度与健肢比较无明显差异。结论非骨化性纤维瘤是一种良性溶骨性病变,临床上应结合影像及病理的特征来做出诊断,本瘤经病灶清除植骨后预后良好。     

长骨骨化性纤维瘤的诊治（附3例报道）

1　病历摘要1.1　病例 1　女性 ,16岁 ,病变部位是胫骨上端。因局部疼痛、肿胀 2周就诊 ,体检发现 :胫骨中上段骨性隆起 ,轻微压痛。Ｘ线片示 :胫骨上段骨骺线以下至中段胫骨骨干前侧皮质病变 ,呈偏心性膨胀性囊性改变 ,病灶内见骨嵴 ,胫骨轻度向前弯曲 ,未见骨膜反应。术前诊断 :骨囊肿。治疗 :彻底刮除肿瘤病灶 ,石炭酸骨腔壁灭活 ,取自体髂骨植骨 ,石膏外固定 3月 ,术后随访 5年 ,无复发。1.2　病例 2　男性 ,8岁 ,右小腿酸、肿胀、不适近 1年。体检 :右小腿中段轻微肿胀 ,无红、热 ,无压痛。Ｘ线片示 :右胫骨中段多房性改变 ,骨皮质密度…     

非骨化性纤维瘤1例诊治报告

患儿,男,11岁,因"左股骨上端骨折术后2周,复查X线片发现左股骨下端内侧骨破坏4月余"于2013年3月入院。入院时症见:左大腿外侧有手术瘢痕,左下肢活动无异常。查体:左股骨外侧大粗隆下可见一长约10 cm的纵形切口瘢痕,局部无环形压痛及纵轴叩击痛,左股骨下端内侧深压痛阳性,局部皮温如常。实验室检查:血常规、CRP、血清钙、血清磷、血沉、碱性磷酸酶均正常。X线片(图1a,1b)示:左股骨上端骨折钢板内固定术后,断端对位对线     

股骨下段非骨化性纤维瘤1例报道

<正>患者,女,17岁,因右大腿内侧局部隐痛不适2个月入院。患者入院2个月前感右大腿下段内侧隐痛,活动后疼痛明显,休息后好转,X线片检查发现右股骨下段异常信号影。专科检查:右大腿内侧局部无包块,无红肿,无感觉异常,压痛(-),右下肢纵向叩击痛(-),足趾感觉活动可,末梢血运良好。辅助检查:(1)     

Non-ossifying fibroma,fibrous cortical defect and Jaffe–Campanacci syndrome: a biologic and clinical review

Non-ossifying fibroma of bone (NOF) is a common entity, more frequently found in male children and consisting of a solitary eccentric, lytic expanded lesion in the metaphysis of a long bone. The disorder is benign and most often asymptomatic but may result in a fracture requiring therapy. Of some importance is to distinguish NOF from another very similar but smaller lesion, fibrous cortical defect, which is almost always asymptomatic and eccentrically located. Even more striking is a very rarely encountered lesion known as Jaffe–Campanacci syndrome, which also occurs in children who present with typical non-ossifying fibromatous tumors but in multiple sites. In addition, these patients have some systemic and dermal findings resembling those seen in patients with Type 1 neurofibromatosis.     

纤维性骨皮质缺损的影像表现与临床研究价值

目的探讨纤维性骨皮质缺损的影像表现与临床研究价值。方法 26例(29个病灶)均有平片资料,其中12例(13个病灶)有CT资料,3例(4个病灶)有MR I资料,9例(10个病灶)经随访观察1~4年,2例(2个病灶)手术病理证实。对其资料进行回顾性分析。结果 26例共29个病灶,其中股骨远侧干骺部14个,胫骨近侧干骺部7个,胫骨骨干4个,股骨近侧干骺部3个,肱骨近侧干骺部1个;单发19例,多发7例。X线表现:多呈类圆形或椭圆形的低密度灶,切线位呈杯口状或碟状的骨皮质缺损区,病灶内缘可见硬化边,周围未见骨膜反应及软组织肿胀。13个病灶CT表现:缺损可位于骨皮质表层(9个)或骨皮质内(4个),位于骨皮质表层者缺损表面无骨壳,局限于骨皮质内者缺损表面骨壳可完整;7个病灶凹向髓腔并以硬化边与髓腔分隔,但无膨胀性改变或突入髓腔,灶内为均匀软组织密度,未见钙化灶。9个病灶经随访观察,其中4个病灶无改变,4个病灶稍有缩小,1个病灶发展为非骨化性纤维瘤。结论典型的纤维性骨皮质缺损单凭平片即可诊断,但CT、MR I比平片更有价值。     

Cortical desmoid and the four clinical scenarios

We reviewed four patients diagnosed with a cortical desmoid lesion at the distal posterior medial femur. Each case reflects a clinical scenario that can be present. Cortical desmoid is a benign, self-limited entity which occasionally can exhibit aggressive radiologic features. Here, we present the specific imaging features in association with patients history and clinical findings facilitating establishment of correct diagnosis. Exact diagnosis is important in order to avoid unnecessary biopsy and complicated therapeutic strategies.     

Pathogenesis of fibrous cortical defect and non-ossifying bone fibroma

We were able to show in eighty-one cases that fibrous cortical defects or non-ossifying fibromas of the bone occur only in areas, where tendons insert into the perichondrium of the epiphyseal plate. During growth these tumor like lesions move towards the diaphysis following a cortical line, which begins at the point of insertion of the tendon and is parallel to the longitudinal axis of the bone.     

带骨膜腓骨治疗桡骨骨纤维异常增殖症严重骨缺损1例

骨纤维异常增殖症是以病理纤维增殖为基础的良性病变,早在1891年Von Reck inghcuson首先发现本病,直到1942年L ichtenste in与Teffe才正式命名为骨纤维异常增殖症[1]。本病可单发或多发,多发者治疗较困难。在处理骨缺损上方法比较多,笔者曾治疗1例单发于桡骨中上段的骨纤维异常     

带血运骨膜内组合双段腓骨移植治疗下肢长骨骨纤维结构不良致大段骨缺损

目的 探讨下肢长骨大段骨纤维结构不良切除后骨缺损的修复方法.方法 1995年5月至2003年8月,6例骨纤维结构不良患者.男5例,女1例.年龄14～40岁(平均25.5岁).胫骨干2例,股骨干4例.肿瘤切除后骨缺损的长度为15～22 cm.移植双腓骨段长度17～24 cm.均从双侧切取带腓血管的腓骨,在一端将腓血管吻合,使成一条腓血管相连的双段腓骨.将双段腓骨的前内侧骨膜从中央纵行切开并向两侧剥离至骨嵴.双段腓骨折叠,其前内侧面相对,两断端同定,将相对缘游离的骨膜纵行缝合,使其组合为一个骨膜包裹的粗骨.将与双段腓骨相连的腓血管襻在移植体一端制成"U"形,勿形成锐角.能保证血管供血不受影响.解剖出受区血管.将组合的腓骨插入骨折两断端间,如不稳定,加用钢丝或螺钉固定.精确无误地将腓血管与受区血管进行吻合,通过移植体骨膜出血情况判断血管吻合口情况.结果 随访6～10年,平均7.4年.1年后骨性愈合;5年后5例移植骨髓腔再通.移植的双腓骨未发生肿瘤,X线片显示为正常骨骼;1例股骨干于正常骨干远段复发,但移植骨部分未复发.骨移植体愈合好,无发生骨不连、骨感染等并发症.膝关节伸屈功能恢复正常,逐渐恢复日常活动与工作.结论 骨膜内组合双腓骨移植足修复下肢长骨大段缺损的良好方法 .     

单侧骨皮质缺损对长管状骨生物力学的影响

目的探讨长管状骨骨干不同大小的单侧骨皮质缺损对长管状骨生物力学性质的影响。方法取76根三黄鸡胫骨,随机分7组(1.5mm组n=11,2.0mm组n=9,2.5mm组n=13,3.0mm组n=12,3.5mm组n=8,4.5mm组n=11,皮质完整组即正常对照组n=12),于后侧骨皮质造成直径分别为1.5～4.5mm的环形骨缺损,进行三点弯曲单一实验,皮质完整组作为正常组对照。结果缺损直径为1.5mm及2.0mm组鸡胫骨达到结构破坏时的最大载荷与正常组差异无统计学意义(P=0.824,0.865),2.5mm、3.0mm、3.5mm组的最大载荷较正常组降低14%左右,差异有统计学意义(P=0.015,0.010,0.021);4.5mm组较正常组降低23%左右,差异有统计学意义(P=0.001)。结论单侧皮质缺损直径在长管状骨外径的(22.6±1.4)%以内时,不影响其抗弯曲性能;当其超过长管状骨外径的(29.4±2.1)%时,将降低长管状骨的抗弯曲性能,但降低的幅度跟缺损大小并不完全呈正比。     

The West China Hospital radiographic classification for fibrous dysplasia in femur and adjacent bones: A retrospective analysis of 205 patients

ObjectiveThis study aims to investigate the reliability and clinical outcome of a newly developed classification system for patients with fibrous dysplasia (FD) of the femur and adjacent bones, optimizing its evaluation and management.MethodsA total of 205 patients (121 female and 84 male) with FD in the femur and adjacent bones were included in this retrospective study. All affected femurs were measured and treated based on this classification at our institution between 2009 and 2019. Based on previous studies and extensive clinical follow‐up, we cautiously proposed the West China Hospital radiographic classification for FD in femur and adjacent bones following corresponding treatment options. There are five types with five radiographic features, including proximal femur bone loss, coxa vara, femoral shaft deformity, genu valgum, and hip arthritis. The intraobserver and interobserver reproducibility of this classification was assessed by four observers using the Cohen kappa statistic. The clinical outcome was evaluated using the criteria of Guille.ResultsAt a median follow‐up of 60 months (range 6–120), 205 patients (median 34.8 years old, range 18–73 years old) were categorized into the following five types: Type I 31.7%, Type II 30.2%, Type III 20.5%, Type IV 10.2%, and Type V 7.3%. The mean interobserver and intraobserver kappa scores were 0.85 (range 0.77–0.89) and 0.85 (range 0.79–0.92), respectively. For clinical outcomes, there was no significant difference in the postoperative Guille score for Type I patients (mean 9.01 ± 1.22). There was a significant increase in the postoperative Guille score in Type II, III, IV, and V, compared to the preoperative values (P < 0.01). For complications, two Type III patients reported pain, and one Type III patient had mild‐to‐moderate Trendelenburg gait. One Type IV patient had a mild Trendelenburg gait. And two Type V patients still had mild limping.ConclusionThis classification is reproducible and serves as a tool for evaluating and treating FD in the femur and adjacent bones. Therefore, we recommend this classification for the diagnosis and treatment of FD‐related deformities in the femur and adjacent bones.     

自体与同种异体骨移植修复四肢长骨骨缺损的对比研究

目的比较自体与同种异体骨移植修复四肢长骨骨缺损的临床效果。方法回顾性分析132例异体骨和97例自体骨修复重建四肢长骨骨缺损患者的临床治疗资料,比较两种方法愈合时间、骨性愈合评分（按Jorgenson标准）、并发症发生率及植骨失败率。结果异体骨重建组132例,4例因感染致植骨失败需行病灶清除灌洗加自体骨移植,10例发生局部排斥反应,其余118例患者术后骨缺损获得良好修复,愈合时间（17．6±1．9）周。骨性愈合评分2．7±0．5。自体骨重建组97例,9例出现供区疼痛、切口感染及局部皮肤麻木等供区并发症,骨缺损均获得良好修复,愈合时间（17．4±23）周,骨性愈合评分2．84±0.3。两组之间在愈合时间、并发症发生率以及愈合评分方面的差异无统计学意义（P〉0．05）;在植骨失败率方面的差异有统计学意义（P〈0．05）。结论运用同种异体骨和自体骨移植重建四肢长骨骨缺损,均能获得满意结果且疗效相似。异体骨移植术后感染致植骨失败以及排斥反应发生率较高,而自体骨移植则多表现为供区的并发症。