植骨内固定治疗成人股骨近端纤维结构不良13例

回顾性分析2000-03/2006-06北京大学深圳医院骨科收治的成年股骨近端纤维结构不良患者13例,男6例,女7例,年龄21～35岁.11例患者有轻度髋部隐痛,其中6例因疼痛加重出现轻度跛行而就诊,2例因出现明显的骨折表现而急诊.植骨内固定前均行X射线,CT检查,3例行MRI检查.单骨病损10例,多骨病损3例,均无内分泌紊乱.病损范围:股骨颈部受损患者9例:股骨转子部受损4例.均采用病灶彻底刮除、自体皮质骨和同种异体骨植骨加动力髋螺钉,股骨近端髓内钉内固定重建的方法进行治疗.13例患者植骨内固定均顺利完成,无意外发生,内固定时间120～210 min,平均159 min.植骨内固定后早期不负重活动,平均3个月骨折愈合,随访18～48个月,症状缓解,俄关节功能良好,步态基本正常.X射线平片显示骨皮质增厚,病损植骨区内有结实的骨化;仅4例有部分骨吸收,无临床复发.提示彻底刮除病灶、带皮质的自体和同种异体骨植骨加动力髋螺钉/股骨近端髓内钉内固定是治疗成人股骨近端纤维结构不良可靠的方法,疗效满意.

Bone grafting and internal fixation for treating fibrous dysplasia of the adult proximal femur A 13.case report

The present study retrospectively analyzed 13 patients with fibrous dysplasia of the adult proximal femur who received treatment at the Department of Orthopedics,Shenzhen Hospital,Peking University between March 2000 and June 2006.These patients comprised 6 males and 7 females,with an age of 21-35 years.Among 11 patients suffering from mild hip pain,6 presented with mild limping due to worsened pains,and 2 exhibited obvious manifestations of bone fracture.All patients underwent X-ray,CT examinations,and 3 were subjected to MRI examinations,prior to bone grafting and internal fixation.Monostotic lesion was observed in 10 patients and polystotic lesion in 3 patients,but endocrine disturbance was not observed in any patient.Nine patients suffered from lesions in the femoral neck and 4 from lesions in the femoral rotator.Curettage,autogenous and allogeneic bone grafting,and internal fixation with dynamic hip screws and proximal femoral nails were successfully performed in each patient.Internal fixation time averaged 165 minutes (range 120-210 minutes).During the early stage after surgery,weight-bearing activities were not permitted.Bone fracture healed after an average of 3 months.Eighteen to forty-eight months of follow-up demonstrated that clinical symptoms were relieved,with good hip joint function and basically normal gait.X-ray plains showed thickened cortical bone,as well as compacted ossification shadow in bone grafting region.In addition,partial bone absorption,but not recurrent clinically,was observed in 4 patients.These findings imply that thorough curettage,autogenous and allogeneic bone grafting,and internal fixation with dynamic hip screws and proximal femoral nails is a reliable method to treat fibrous dysplasia of the adult proximal femur and it can acquire satisfactory curative effects.