| IntroductionFibrous dysplasia (FD) is a benign intramedullary fibro-osseous lesion originally described by Lichtenstein in1938and by Lich-tenstein and Jaffe in1942. Fibrous dysplasia is a genetic, non-inheritable disease. Fibrous dysplasia can present in one bone (monostotic) or multiple bones (polyostotic) and can be associated with other conditions. FD may occur in isolation or as a part of McCune-Albright syndrome (MAS), which includes endocrine abnormalities, cafe-au-lait pigmented skin lesions, and FD. Common sites of skeletal involvement are long bones, ribs, craniofacial bones, and the pelvis. The key histologic features of fibrous dysplasia are delicate tropical of immature bone, with no osteoblastic rimming, enmeshed within a bland fibrous stroma of dysplastic spindle-shaped cells without any cellular features of malignancy. More and more studies show that FD is a genetic, non-inheritable disease due to mis-sense mutations occurring post-zygotically in the gene coding for the a-subunit of the stimulatory G-protein, Gs, in the GNAS complex. Monostotic presentation is more frequent, and lesions enlarge in proportion to skeletal growth. The incidence and prevalence of FD are estimated to7%of benign bone tumor. The clinical presentation may occur at any age, with the majority of lesions being detected by the young and middle-aged. A small proportion of patients also have endocrine abnormalities, most often precocious puberty. The clinical manifestations of FD of bone pain, bone deformity or fragility fracture. FD has been often asymptomatic at an early stage. In many patients, however, the disease is diagnosed because of bone pain or fragility fracture. The radiographic features of the FD are a grayish "ground-glass" pattern on the X-ray. The lesion characteristically bounded by a distinct rim or shell of reactive bone that is defined more sharply on its inner border than on its outer border, where it may fade gradually into normalcancellous bone. The diagnosis is based on clinical manifestations, imaging studies and pathological combination. If the patients are difficult to diagnose, the genetic testing will be used. Malignant transformation of fibrous dysplasia occurs very infrequently, with reported prevalences ranging from0.4%to4%. The most common malignant tumors were osteosar-coma, fibrosarcoma, and chondrosarcoma. Patients with Mazabraud syndrome may have a higher risk of malignant transformation. The patients who received radiation therapy, which increases the risk of malignant transformation. Asymptomatic patients of FD can be seen regularly radiography to observe the progress of the disease situation. Bisphosphonate therapy has been utilized for patients with symptomatic polyostotic disease. It is a potent inhibitor of bone resorption and has a lasting effect on bone turnover. The major effect was decreased bone pain and reduce fractures and deformities incidence. Surgery is still the main treatment for FD. Surgical procedures may be required for correction of a deformity, prevention of pathologic fracture, and/or eradication of symptomatic lesions. The development of tissue engineering provides support to allograft tissue transplants. Clinically proven that there was no difference on the function score and the long-term efficacy on allograft and autograft. Bone allograft has been widely used to repair due to tumor, infection caused by post-traumatic bone defects. Fixation techniques for orthopedic provide a strong support. FD research, especially in the study of the etiology and pathogenesis of clinical diagnosis and treatment in recent years to provide guidance. Bisphosphonate medications and surgical techniques improve, more and more patients with FD benefit. FD treatment but still faces challenges.ObjectiveTo evaluate the efficacy of surgical treatment with bone allografts in patients of fibrous dysplasia.To evaluate the efficacy of surgical treatment with bone autografts in patients of fibrous dysplasia.MATERIALS AND METHODS 1Patients and Tumor Samples.We retrospectively identified78patients with primary osteosarcoma occurring between2001and2011who met the following criteria:(1) clear pathological diagnosisn;(2) integrity of the medical records;(3) lesions of limbs;(4) no history of previous treatment;(5) surgical treatment in our hospital(6)use bone allografts and bone autografts only.Among the78selected patients, there were42males and36females with an average age of26.50±14.81years (range,8-70years).71cases presented with metastatic FD,7cases presented with polyostotic FD. The locations of the tumor where the femur (36cases), tibia (22cases), humerus (14cases), radius and ulna (6case). The clinical manifestations of patients included local pain (50cases), pathologic fracture (12cases), deformity (6cases), masses (6cases) and other (4cases).The average duration were2.84±0.85years((range,2months to11years).2TreatmentAfter admission perfect routine examination and preoperative preparation for the performance of typical cases, surgical treatment; revealed and surgical lesions according to the different parts, the use of different surgical approach. Biopsy confirm the diagnosis before surgical treatment for atypical cases. Not associated with malformation patients, the lesion site window, thorough curettage of the lesion, high-speed electric drill grinding, carbolic acid, alcohol burns parietal, sterile water for injection rinse after implantation of a sufficient amount of allograftbone (Beijing Xin Kang Chen Medical Science and Technology development Co., Ltd.) or taken from the bone (iliac, femoral condyle, the fibula). According to the lesion, the range, the size of the patient’s condition to decide whether the selection of plates, screws or intramedullary nail effectively fixed. Patients with malformations, first osteotomy, curettage of the lesion, bone grafting, and internal fixation.3Evaluation criteriaThe patient pain-related complications and limb function assessment (MSTS scores) was evaluated one month after operation, on a regular basis (3-6months) by imaging studies assess bone graft remodeling situation. Quality:no pain, no activity limitation of limb function, the transplanted bone completely remodeling; satisfied: there is some defect imaging findings as mild, small osteolysis, does not affect the biomechanics of the bone, and do not affect limb function no pain; poor:lack of bone graft remodeling or local recurrence, affecting bone biomechanics.4. Statistical analysisAll the data were processed by Spss13.0. All the data were noted in meandn±standard deviation (mean±SD); Quantitative data were compared by means of two independent samples T-test. Qualitative data were compared by means of the χ2 test.Statistical significance was set at P<0.05.Results52cases of allograftbone transplantation in patients with postoperative infection, rejection and other complications of allograftbone. The operative time of52cases were1.67±0.55hours (0.8to3hours). The intraoperative blood loss of these cases were188.57±72.75ml (80to400ml).Over42patients were followed up for a mean follow-up of28.81±15.32months (6months to108months). Excellent results for30cases satisfied the nine cases, deviation of the three cases.The MSTS scores were28.79±3.01(17to30scores) and the overall effective rate was92.8%(39/42).The bone graft healing time were15.04±3.36months (12to24months).3relapsed patients were again be expand curettage, bone grafting and internal fixation treatment. The intramedullary nail treatment was used after one case of steel plate, screw loose.26patients with bone autograft had no infection postoperative and incision healed well. The operative time of26cases were1.97±0.58hours (1.2to3.5hours). The intraoperative blood loss of these cases were237.31±82.49ml (100to450ml).16patients were followed up for a mean follow-up of21.63months (6months to36months). Excellent results for the eight cases, satisfied the six cases, the difference of the two cases. The MSTS scores were28.00±3.37scores(18to30scores) and the overall effective rate was87.5%(14/16). The bone graft healing time were13.57±2.37months (10to24months).2relapsed patients were be again expand curettage, bone allograft and internal fixation.The operative time of bone allograft used were shorter than bone autograft, there are difference (P=0.028) via being checked by statistical tests.The blood loss of bone allograft were less than bone autograft, there are difference (P=0.009) via being checked by statistical tests.Curative effects of bone allograft and bone autograft on fibrous dysplasia are equal to each other (P=0.899) and there are no difference on the bone graft healing time (P=0.138) via being checked by statistical tests.ConclusionBoth allograft bone grafting and autograft bone grafting are effective method for treating fibrous dysplasia.Bone allograft and bone autograft are equal to each other in curative effect of fibrous dysplasia. Bone allograft required shorter operative time and less blood loss. |
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