儿童先天性胫骨假关节愈合后应用Ilizarov技术行胫骨近端延长的疗效分析  

Proximal tibial lengthening using llizarov technique after healing of congenital pseudarthrosis of the tibia in children

作　　者：梅海波[1] 赫荣国[1] 刘昆[1] 伍江雁[1] 唐进[1] 胡欣[1] 谭谦[1] 叶卫华[1] 朱光辉[1] 严安[1] 黄生祥[1] 谭晓谦[1] 张妮[1] 

机构地区：[1]湖南省儿童医院骨科、南华大学儿科学院,长沙410007

出　　处：《中华创伤骨科杂志》2013年第10期858-862,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨儿童先天性胫骨假关节（CPT）愈合后应用Ilizarov技术行胫骨近端延长的疗效。方法2007年3月至2012年1月应用Ilizarov技术对11例儿童CPT愈合后患者进行胫骨近端骨延长，男10例，女1例；平均年龄为8岁5个月（3岁9个月至14岁5个月）。胫骨平均短缩5．6cm（2．0～8．2cm）。8例患者的正、侧位X线片示伴有胫骨近端发育不良。10例患者合并1型神经纤维瘤病（NF．1）。按照延长指数、愈合指数及骨痂形态评价治疗结果并分析相关影响因素。结果11例患儿术后获1年2个月至4年3个月（平均2年3个月）随访，平均延长长度为5．3cm（3．5-8．0cm）,平均愈合指数为63。1d／cm（47-77d／cm）。8例伴有胫骨近端发育不良患者延长过程中骨痂再生不良，形成的骨痂形态为侧边形（5例）或中央形（3例），平均愈合指数为67．0d／cm，其余3例骨痂形态为凹陷型，平均愈合指数为52．7d／cm。5例患者发生针道感染。未发生轴向移位、延长段骨不愈合和延迟愈合。结论CPT愈合后应用Ilizarov技术行胫骨延长有一定治疗效果，但其骨痂生长缓慢，愈合指数较大。伴有NF-1和胫骨近端发育不良可能影响其胫骨延长。Objective To investigate clinical outcomes of proximal tibial lengthening by distraction osteogenesis （Ilizarov technique） after healing of congenital pseudarthrosis of the tibia （CPT） in children. Methods From March 2007 to January 2012, 11 children received proximal tibial lengthening by distraction osteogenesis （Ilizarov technique） after successful union of CPT. They were l0 boys and one girl, with an average age of 8 years and 5 months （range, from 3 years and 9 months to 14 years and 5 months）. The tibial shortening averaged 5.6 cm （from 2. 0 to 8.2 era）. The anteroposterior and lateral X-ray films revealed proximal tibial dysplasia in 8 children. And 10 children are complicated with type 1 neurofihromatosis（NF-1 ）. The clinical outcomes were assessed by the lengthening index, healing index and morphological evaluation of callus. Relative risk factors were also analyzed. Results All the 11 children were followed up from one year and 2 months to 4 years and 3 months （average, 2 years and 3 months） . The average lengthening was 5, 3 cm （from 3.5 to 8.0 era） . The average healing index was 63.1 d/em （from 47 to 77 d/era） . The 8 children with proximal tibial dysplasia developed callus maldevelopment during the lengthening, with lateral callus formation in 5 and central callus formation in 3 cases. The callus formation was hollow in the other 3 cases who had an average healing index of 52. 7 d/era, Pin tract infection occurred in 5 eases, hut there was no axial displacement, bone non-union or delayed union of the lengthened segment. Conclusions Proximal tibial lengthening using llizarov technique after healing of CPT is effective, but the callus growth is slow and the length- ening index is high. The tibial lengthening can be affected by concomitant NF-1 and proximal tibial dysplasia.

关 键 词：下肢畸形 先天性 骨延长术 伊利扎罗夫技术 儿童 

分 类 号：R726.8[医药卫生—儿科]