股骨近端纤维发育不良的手术治疗:文献综述。

IF 1.4 Q3 ORTHOPEDICS
Tiago Soveral Pereira, Nuno Malheiro, Daniel Gonçalves, Catarina Rodrigues, Paulo Jorge Gonçalves
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引用次数: 0

摘要

目的:纤维性发育不良是一种罕见的疾病,其表现和骨累及模式均不相同。股骨近端周围的病变是最常见的。本文回顾了文献中描述的不同手术选择,并总结了最近治疗股骨近端病变的建议。方法:全面回顾文献,分析手术技术,包括刮除植骨、截骨矫正畸形、骨折固定方法和全髋关节置换术(THA)。结果:刮骨和植骨虽然是传统的治疗方法,但由于复发率高,疗效有限,在很大程度上不受欢迎。截骨术,特别是外翻转子间截骨术和转子下截骨术,对于纠正诸如牧羊人弯曲畸形等畸形是有效的,髓内固定目前被认为是金标准。骨折固定仍然是个体化的,根据骨折类型、病变在股骨近端位置和患者年龄选择多种植入物,包括髓内钉和固定角度装置。全髋关节置换术是治疗终末期骨关节炎和部分急性骨折病例的可行选择,在必要时通过骨移植物增强无骨水泥构件,显示出良好的效果。结论:股骨近端FD的手术治疗是多方面的,并根据个体患者的表现量身定制。尽管取得了进展,但仍然没有标准化的方法,强调需要进行高质量的研究以建立共识指导方针。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Surgical treatment of fibrous dysplasia in the proximal femur: a literature review.

Purpose: Fibrous dysplasia is an uncommon disease with heterogeneous presentations and patterns of bone involvement. Lesions around the proximal femur are the most common. The article reviews the different surgical options described in the literature and summarizes recent recommendations in managing proximal femoral lesions.

Methods: A comprehensive review of the literature was conducted to analyze surgical techniques, including curettage with bone grafting, osteotomies for deformity correction, fixation methods for fractures, and total hip arthroplasty (THA).

Results: Curettage and bone grafting, while traditionally used, are largely discouraged due to high recurrence rates and limited efficacy. Osteotomies, particularly valgus intertrochanteric and subtrochanteric osteotomies, are effective for correcting deformities such as the Shepherd's crook deformity, with intramedullary fixation currently being considered the gold standard. Fracture fixation remains individualized, with a range of implants, including intramedullary nails and fixed-angle devices, chosen according to the fracture pattern, localization of the lesion within the proximal femur and patient age. THA is a viable option for end-stage osteoarthritis as well as select cases of acute fractures, with cementless components, augmented by bone grafts when necessary, showing favorable results.

Conclusions: Surgical management of proximal femoral FD is multifaceted and tailored to individual patient presentations. Despite advancements, there is still no standardized approach, emphasizing the need for high-quality studies to establish consensus guidelines.

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来源期刊
CiteScore
3.00
自引率
5.90%
发文量
265
审稿时长
3-8 weeks
期刊介绍: The European Journal of Orthopaedic Surgery and Traumatology (EJOST) aims to publish high quality Orthopedic scientific work. The objective of our journal is to disseminate meaningful, impactful, clinically relevant work from each and every region of the world, that has the potential to change and or inform clinical practice.
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