自体腓骨移植治疗胫骨骨纤维结构不良

目的：探讨病灶边缘切除+自体腓骨移植重建胫骨+内固定的手术方式治疗胫骨骨纤维结构不良的疗效。方法1997年1月至2010年12月间我科对10例胫骨骨纤维结构不良（osteofibrous dys?plasia, OFD）的患儿行胫骨病灶骨膜下边缘切除，保留胫骨后壁，所遗骨缺损以自体健侧腓骨移植加钢板内固定重建。移植腓骨长为6~20 cm，平均12.2 cm。术后随访时间为4~12年，平均为6.6年。结果10例患儿术后依据病检有3例最后诊断为似釉质细胞瘤（adamantinoma, AD）的OFD或典型的AD。骨纤维结构不良病灶行骨膜下病灶切除术均未发生术后复发。移植的自体腓骨术后3~8个月（平均4.5个月）达到骨性愈合，双下肢基本等长，功能接近正常。结论骨纤维结构不良因易与釉质细胞瘤混淆，且有发生病理性骨折和有恶变的可能性，建议以手术治疗取代保守治疗。自体腓骨移植重建胫骨骨纤维结构不良病灶切除后骨缺损，游离腓骨骨移植加钢板固定术与带血管腓骨移植效果相当，但方法简单、操作难度小，可最大限度地恢复患肢功能。

Fibula autograft for treating tibial osteofibrous dysplasia

Objective To study the treatment outcome of tibial osteofibrous dysplasia by utilizing the margin excision method of the tibia and reconstruction by free vascularied fibula autograft with internal fixation. Methods From January 1997 to December 2010, surgery was performed on 10 children with tibial osteofi?brous dysplasia. Our patient group consisted of 7 female and 3 male, with a mean age of 4.5 years (range, 2?12 years). The operation included the following procedures:tibial subperiosteal margin excision, retaining the pos?terior of the tibia and the bone reconstruction by utilizing free vascularized fibula autograft with internal fixa?tion. The mean length of fibula autograft was 12.2 cm (range, 6?20 cm). All patients were followed up for an aver?age of 6.6 years (range, 2?12 years). Results Three patients were finally diagnosed as typical adamantinaoma or similar disease in these 10 patients who were initially diagnosed as osteofibrous dysplasia. The subperiosteal margin excision of the tibial osteofibrous dysplasia would not result in more recurrence. Bony healing was achieved in an average of 4.5 months (range, 3?8 months) after surgery of autologous fibula. Meanwhile, the dou?ble lower extremities isometric and the good limb functions of the patients were obtained well. Conclusion Os?teofibrous dysplasia is often confused with adamantinoma easily. Surgery should be recommended to replace the conservative treatment due to the potential of pathologic fracture and malignant onset. The reconstruction of the free vascularized fibia autograft with internal fixation is as equal as the vascularized fibia graft to treat the bone defect. Moreover, the former needs less difficulty and shorter operation time, and the limb functions are restored finally.