儿童腓骨头骨骺移植重建内踝的中长期随访观察  

Middle and long term follow-up for medial malleolus reconstruction by fibular head epiphysis in children

作　　者：刘雪涛[1] 李忠[1] 高志刚[1] 王涛[1] 王剑利[1] 

机构地区：[1]解放军第89医院创伤骨科,山东潍坊261021

出　　处：《中国骨与关节损伤杂志》2015年第12期1283-1286,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的 对儿童腓骨头骨骺移植重建内踝的中长期疗效进行临床评价。方法 自2004-01—2013-10采用腓骨头骨骺移植重建治疗11例内踝缺损的患儿,经中长期随访,观察患儿的症状及膝、踝关节功能、影像学改变。结果 本组11例患儿移植组织全部成活,11例获得1-10年,平均6年7个月随访。11例患儿走、跑、跳功能正常,能正常上学、参加体育活动,3例大运动量后感踝关节酸胀,休息缓解。疗效按照膝关节功能按照HSS评分：优9例,良2例;踝关节功能按照AOFAS评分：优5例,良3例,可2例,差1例;影像学资料显示11例患儿腓骨近端骨缺损逐渐延长,内踝逐渐发育,足踝部出现影像学改变。按照踝部X线评分：优4例,良4例,可2例,差1例。并发症处理：3例皮瓣修整,1例骨桥切除、脂肪填塞（10岁）,1例骨骺阻滞（13岁）,1例截骨矫形（16岁）,1例足趾肌腱松解。结论 腓骨头骨骺移植重建内踝对于供区（膝、踝）无明显影响,功能恢复满意,在随访中应根据影像学改变做出针对性处理,以获得优良的远期效果。Objective To evaluate the middle and long-term efficacy of fibular head epiphysis transplantation for reconstruction of medial malleolus in children. Methods From January 2004 to October 2013, 11 cases of medial malleolus defect in children were treated by the transplantation. The postoperative middle and long-term follow-up was carried out, the children＇s symptoms, function of knee and ankle joint, evaluated the image change were observed. Results The transplanted tissue of 11 cases all survived. The follow-up ranged from 1 year to 10 years, average 6 years 7 months. All cases got normal function of walking, running, jumping, going to the school and taking part in sports, 3 cases had ankle acid bilges fatigue after large amount of exercise and recovered after rest. Knee joint function according to HSS： excellent in 9 cases, good in 2 cases;ankle joint function according to AOFAS： excellent in 5 cases, good in 3 cases, fair in 2 cases and poor in 1 cases; imaging data display that the proximal fibula bone defect extended, the medial malleolus growed, foot and ankle changed with different degree. According to the ankle score X-ray, excellent result was in 4 cases, good in 4 cases, general in 2 cases and poor in 1cases. For the management of the complications： flap trimming was in 3 cases, bone bridge excision and fatty tamponade in 1case（10 years old）, epiphyseal arrest in 1 case（13 years old）, osteotomy in 1 case（16 years old）, tenolysis in 1 case.Conclusion There were no significant effect in donor site（knee and ankle） by this method. All cases recovered satisfactorily. In the follow-up visits the specific treatment should be given according to their image change, in order to get excellent long-term results.

关 键 词：内踝 腓骨头 骨骺 生长和发育 

分 类 号：R687.34[医药卫生—骨科学]