Objective: To summarize the diagnosis and treatment process, methods and curative effect of 10 children with fibrous dysplasia of bone. Methods: Operation 10 cases, focus clearance and bone grafting in 9 cases, focus clearance only 1 case. Autologous iliac bone transplantation in 8 cases, calcium phosphate artificial bone transplantation 1 case. Two children with large windows were covered with absorbable medical film to prevent soft tissue growth. Results: 10 children were followed up for 14 years. Pathological fractures healed within 3 ~ 5 months, local pain symptoms disappeared and there was no recurrence. There were no pathological fractures and fracture recurrence cases. X-ray reexamination: local cystic shadow disappeared, cystic cavity ossified and the density was uniform. 10 children have no growth and development obstacles in recent follow-up. 1 case, the focus was located at the dirty end of the lateral epicondylar shaft of femur, the bone scale was destroyed, and the focus broke through the articular cartilage surface. During the operation, only the focus was removed without bone grafting to prevent the callus from closing prematurely. The short-term curative effect is satisfactory, and there is no genu varus. Long-term follow-up is needed. Conclusion: For children who are found early, active treatment is satisfactory in both curative effect and treatment difficulty. Once the pathological fracture occurs, the treatment is more difficult, the healing cycle after operation is prolonged, the pain time of children is prolonged, and the pathological fracture needs to be fixed, which increases the treatment cost.
Key words: fibrous dysplasia of bone; Focal clearance and bone grafting; Bone scale destruction; Pathological fracture
Fibrodysplasia of bone, as a tumor-like bone tissue lesion, is on the rise in recent years with the improvement of people's medical awareness and economic conditions. As a tumor-like lesion of bone tissue, it occupies the first place in the tumor-like lesion of bone tissue. All the cases were teenagers and children, aged about 10 years old. The onset can occur on any bone. Most children have no symptoms and it is not easy to find them in the early stage. As many as 2/3 cases have pathological fractures in the later stage, and most cases take this as the first symptom [1]. From June 2003 to February 2006, the Department of Orthopaedics of kuya Hospital in Mianxian County, Shaanxi Province treated a total of 10 children, including 2 pathological fractures. 65,438+00 children were treated with debridement and bone grafting, and fracture cases were treated with internal and external fixation. Follow-up was 65,438+0 ~ 4 years.
1 data and methods
1. 1 General information: From June 2003 to February 2006, there were 10 cases of children with fibrous dysplasia of bone, including 4 males and 6 females, with an average age of 6.6 years. In this group 10 cases, 2 cases were found with pathological fracture, 2 cases with pain around the focus, and the remaining 6 cases were all with trauma around the focus. X-ray showed fracture of coccyx 1 case found lesser trochanter disease, ankle fracture 1 case found lower tibia disease, and 8 cases were asymptomatic before. Only 2 cases in this group had obvious symptoms. Treatment of local pain of tibial tubercle 1 case. 1 case of lateral epicondyle of femur, the focus destroyed the bone scale and broke through the articular cartilage surface, causing effusion, swelling and pain of the knee joint and limited mobility. The remaining 8 cases were asymptomatic in the past. Imaging examination: X-ray showed expansive osteolytic changes, ground glass-like, partial cystic shadows, irregular calcification and varying degrees of cortical thinning. Laboratory examination: 7 cases of bone alkaline phosphatase increased, the highest was 480 mmol/L, which was 3 times higher than the normal value. Erythrocyte sedimentation rate is normal.
1.2 surgical treatment: ① focus removal: 10 children were treated with local fenestration, and the fenestration area was as small as possible, but the focus tissue was cleaned up and washed under pressure. ② Bone grafting: among the children in this group 10, 9 cases received bone grafting. 1 Children's focus was located at the dirty end of the lateral femoral epicondylar shaft, and the callus was destroyed, and the focus broke through the articular cartilage surface. Only the focus is removed without bone grafting to prevent premature callus closure from affecting growth and development. Among 9 cases of bone graft, 8 cases were from iliac bone graft and 1 case was from calcium phosphate artificial bone graft. Autologous iliac bone transplantation, trimming large iliac bone into small bone strips. Two children with large windows were covered with absorbable medical film to prevent soft tissue from entering.
Two results
Follow-up of this group 10 children 1 ~ 4 years. All the children with fractures healed within 3 ~ 5 months, and the local pain symptoms disappeared without recurrence. X-ray reexamination: local cystic shadow disappeared, cystic cavity ossified and the density was uniform. 10 children have no growth and development obstacles in the near future. 1 case, the focus was located at the dirty end of the lateral epicondylar shaft of femur, the bone scale was destroyed, and the focus broke through the articular cartilage surface. During the operation, only the focus was removed without bone grafting to prevent the callus from closing prematurely. The short-term curative effect is satisfactory, and there is no genu varus. Long-term follow-up is needed.
3 discussion
Most children with fibrous dysplasia of bone are asymptomatic, and they are often found in physical examination, trauma around the focus and joint diagnosis after fracture. A few symptoms caused by the involvement of adjacent joints only feel pain, and most of them are relieved after rest. However, it is common for growing children to have joint pain due to callus growth, and most of them are relieved after rest, so they are ignored and missed until pathological fractures appear. Early detection and treatment can actively prevent the occurrence of pathological fractures. All cases in this group were treated by surgery, focus removal and bone grafting. The purpose is to completely remove the focus, restore the histological structure and biomechanical structure of the focus, and actively prevent the occurrence of long-term pathological fractures. At present, the treatment of this disease is mainly surgical treatment, and curettage and bone grafting are the surgical methods chosen by most colleagues.
Fibrodysplasia of bone is a group of cystic lesions characterized by bone fibrosis, and it is a congenital non-hereditary disease. The etiology and pathogenesis are still unclear. The disease is a tumor-like lesion, and the incidence of local tumor-like lesions is the first, and the incidence in China is higher than that in foreign countries. Women are more common, and the ratio of male to female is 1: 2 ~ 3. Non-surgical treatment methods have been studied abroad, mainly using sodium bisphosphate compounds, and its second generation product, hydroxyethyl sodium phosphate, can relieve pain and slow down the speed of osteolytic changes, but it can not cure the primary lesion; It has not been widely used in China, and surgery is still the main treatment. Surgery can completely remove the lesion in a short time and restore the histological and biomechanical structure of the lesion [2]. We believe that early detection and active treatment of children are satisfactory in both curative effect and treatment difficulty. Once pathological fracture occurs, the treatment difficulty is greatly increased, the postoperative healing cycle is prolonged, the pain time of children is prolonged, and the pathological fracture needs to be fixed, which increases the treatment cost. This group 10 children were followed up 1 ~ 4 years, and the effect was satisfactory. There were no pathological fractures or recurrent fractures. Recent literature reports on gene therapy for this disease are expected to break through.
10 The children in this group are localized lesions and single lesions. Symptomatic children only have local pain, no skin pigmentation, precocious puberty and other manifestations, and the diagnosis is not difficult. No local deformity, simple operation method. There are few cases with large lesions and multiple invasions, and the conclusion is limited. Individual cases need long-term follow-up.
4 references
[1] Xu Shaoding, Guo Baofeng, Xu Yinque. Practical orthopedics [M]. Second edition. Beijing: People's Military Medical Publishing House, 2002: 1275.
Geng Bin. Systematic Review of Bone Morphogenetic Protein in the Treatment of Fracture [J]. China Journal of Orthopaedics, 20 10, 23(5): 1949.