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目的探讨严重内翻畸形的股骨近端骨纤维结构不良(fibrous dysplasia,FD)的治疗方法。方法 2001年1月至2011年12月,收治26例股骨近端严重髋内翻伴肢体短缩畸形的FD患者。颈干角35°～100°,平均78°,股骨相对长度较对侧短缩2.0～9.5cm,平均4.2cm。26例均行股骨近端畸形顶点附近外翻截骨,股骨头、颈及截骨断端打压式植骨,嵌插复位DHS或DCS钢板固定。结果术后23例获得随访,随访时间6个月至10.5年,平均4.8年。22例内固定可靠,1例DHS内固定物股骨头螺纹钉术后1年切割出股骨头2mm,疼痛,经取出内固定物后治愈。股骨力线均基本矫正,截骨面达骨性愈合,髋内翻畸形的颈干角矫正为95°～130°,平均119°,股骨相对长度矫正后较术前延长2.5～8.6cm,平均3.7cm,术前肢体短缩基本纠正。术后17例患者步态正常;2例扶单拐行走,5例不扶拐轻度跛行。术后19例疼痛消失,4例疼痛明显减轻。所有患者无感染、再骨折和畸形进展。结论股骨近端FD严重髋内翻伴肢体短缩畸形行股骨近端畸形顶点附近外翻截骨,股骨头、颈及截骨断端打压式植骨,嵌插复位DHS或DCS钢板固定是一个简单有效的治疗方法。同时,股骨近端加长的DHS或DCS钢板对FD患者的骨质结构有明显的加强作用,特别是维持股骨近端及颈干角的解剖力线能起到很大的作用,以避免畸形复发。
Objective To investigate the treatment of severe dysplasia of proximal femur with fibrous dysplasia (FD). Methods From January 2001 to December 2011, 26 patients with FD patients with proximal femur severe hip varus and limb shortening deformity were treated. Neck angle of 35 ° ~ 100 °, an average of 78 °, the relative length of the femur contralateral 2.0 ~ 9.5cm, an average of 4.2cm. Twenty-six patients underwent valgus osteotomy near the apex of the proximal femoral deformity. The femoral head, neck and osteotomy were impacted at the tip of the proximal femur, and inserted into the DHS or DCS plate for fixation. Results 23 cases were followed up for 6 months to 10.5 years with an average of 4.8 years. Twenty-two cases were reliably fixed. One case of femoral head screw fixation with DHS was excised as 2 mm femoral head 1 year after operation, and the pain was removed. The internal fixator was removed and cured. The femoral strength lines were basically corrected and the osteotomy surface reached the bony union. The correction of crooks was corrected to 95 ° ~ 130 ° with an average of 119 °. The relative length of the femur was 2.5 ~ 8.6 cm longer than that before the operation, with an average of 3.7cm, preoperative limb shortening basic correction. Seventeen patients had normal gait after operation; two patients got helpless walking and five patients did not have mild limping. 19 cases of pain disappeared, 4 cases of pain was significantly reduced. All patients without infection, and then fracture and deformity. Conclusions The proximal femoral fractures of the severe hip varus with limb shortening deformity around the apex of the femoral proximal femoral trochanter, femoral head, neck and osteotomy broken end impaction bone graft, insertion reset DHS or DCS plate fixation is a Simple and effective treatment. At the same time, the DHS or DCS steel plate with the proximal femur lengthening obviously enhances the bone structure of FD patients, especially the anatomical force lines that maintain the proximal femoral neck and the angle of the neck can play a significant role to avoid recurrence of deformity .