儿童先天性胫骨假关节行胫骨近端延长的临床疗效评价  

Clinical evaluation of proximal tibial extension in children with congenital pseudarthrosis of the tibia

作　　者：刘尧喜 伍江雁[1] 杨戈 谭谦[1] 刘昆[1] 黄一勇 李淼[1] 肖汉 胡雄科 易银芝[1] 朱光辉[1] 梅海波[1] Liu Yaoxi;Wu Jiangyan;Yang Ge;Tan Qian;Liu Kun;Huang Yiyong;Li Miao;Xiao Han;Hu Xiongke;Yi Yinzhi;Zhu Guanghui;Mei Haibo(Department Orthopedics of Hunan Provincial Key Laboratory of Pediatric Orthopedics,Hunan Children's Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院骨科,儿童骨科湖南省重点实验室,长沙410007

出　　处：《临床小儿外科杂志》2024年第2期147-151,共5页Journal of Clinical Pediatric Surgery

基　　金：湖南省卫生健康委一般指导课题(D202304078395);湖南省科卫联合基金(2022JJ70007,2021JJ70081);湖南省临床医疗技术创新引导项目(2021SK50526)

摘　　要：目的评估儿童先天性胫骨假关节(congenital pseudarthrosis of the tibia,CPT)行胫骨近端延长的愈合指数及并发症情况。方法回顾性分析2012年2月至2019年12月湖南省儿童医院骨科使用伊氏外固定装置行胫骨近端延长手术的57例CPT患儿临床资料,平均随访时间72.9个月。根据愈合指数的平均值分组,愈合指数小于57.1 d/cm为A组(n=32),大于57.1 d/cm为B组(n=25)。于胫骨近端延长治疗结束后1个月行X线检查,采用Li分类法评估骨痂质量,并随访患儿胫骨延长术后并发症情况。结果57例CPT患儿平均愈合指数为57.1 d/cm。A组手术时平均年龄为80个月,平均随访时间为75.5个月,平均延长长度为5.9 cm,延长结束后1个月骨痂形态质量良好者占81%(26/32),愈合指数为39.1 d/cm。B组手术时平均年龄为100.9个月,平均随访时间为69.6个月,平均延长长度为4.9 cm,延长结束后1个月骨痂形态良好者占56%(14/25),愈合指数为80.1 d/cm。57例中,3例于胫骨延长过程中腓骨提前愈合,5例出现针道感染,3例踝关节僵硬,1例出现踝关节跖屈20°畸形,4例出现延长段成角畸形,8例膝关节活动受限。结论CPT患儿胫骨延长过程中平均愈合指数为57.1 d/cm,存在腓骨提前愈合、延长段成角畸形等并发症,延长过程中需密切关注骨痂形态。Objective To evaluate the healing index and complications of proximal tibial lengthening in children with congenital pseudarthrosis of the tibia(CPT).Methods From February 2012 to December 2019,retrospective analysis was conducted for clinical data of 57 CPT children undergoing proximal tibial extension using Ilizarov external fixation device.The average follow-up period was 72.9 months.According to the average value of healing index,group A had a healing index<57.1 cm/d and group B a healing index of>57.1 cm/d.At Month 1 post-operation,radiographic examination was performed for evaluating the quality of callus with Li classification.Postoperative complications of tibial lengthening were recorded.Results The average healing index was 57.1 d/cm.The average operative age was 80 months in group A with an average follow-up period of 75.5 months and an average extension length of 5.9 cm.And 81%of them obtained decent callus morphology and quality after 1-month extension with a healing index of 39.1 d/cm.The average operative age was 100.9 months in group B with an average follow-up time period of 69.6 months.The average extension length was 4.9 cm.And 56%of them obtained decent callus morphology after 1-month extension with a healing index of 80.1 d/cm.There were early fibular healing during tibial lengthening(n=3),needle infection(n=5),ankle joint stiffness(n=3),20 degree deformity of ankle metatarsal flexion(n=1),extended segment angulation deformity(n=4)and limited movement of knee joint(n=8).Conclusions The average healing index of CPT children is 57.1 d/cm during tibial lengthening.There are such complications as early fibular healing and angled extension segments.During lengthening,close attention should be paid to the morphology of callus.

关 键 词：先天性胫骨假关节 胫骨 骨延长术 骨痂 治疗结果 

分 类 号：R726.8[医药卫生—儿科]