儿童先天性胫骨假关节愈合后的X线分型与术后再骨折的相关性研究  

Correlative study between X-ray type after healing of congenital pseudarthrosis of the tibia in children and postoperative refracture

作　　者：刘尧喜 梅海波[1] 刘昆[1] 伍江雁[1] 唐进[1] 赫荣国[1] 朱光辉[1] 叶卫华[1] 胡欣[1] 严安[1] 易银芝[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：《中华外科杂志》2016年第6期456-460,共5页Chinese Journal of Surgery

摘　　要：目的 探讨儿童先天性胫骨假关节（CPT）愈合后的X线分型与术后再骨折之间的关系.方法 回顾性分析2007年12月至2012年8月湖南省儿童医院收治的67例CrawfordⅣ型CPT患儿的临床资料.男性患儿46例,女性患儿21例;左侧CPT 37例,右侧CPT 30例;伴有胫骨近端发育不良12例.56例患有神经纤维瘤病1型,手术时中位年龄2.8岁（0.6～11.2岁）.根据先天性胫骨假关节患儿实现胫骨假关节愈合2年时胫骨假关节愈合区域横断面积与胫骨假关节愈合区域移行区横断面积的比值大小,分为肥大型组、中间型组、萎缩型组,比较3组患儿再骨折的发生情况.结果 肥大型组有38例CPT患儿,其中发生再骨折5例,再骨折发生率为13％;中间型组有21例CPT患儿,其中发生再骨折3例,再骨折发生率为14％;萎缩型组有8例CPT患儿,其中5例发生再骨折,再骨折发生率为5/8.中间型组患儿的再骨折发生率比肥大型组高,差异无统计学意义（P=0.592）;萎缩型组患儿的再骨折发生率比肥大型组高,差异有统计学意义（P =0.007）;萎缩型组患儿的再骨折发生率比中间型组高,差异有统计学意义（P=0.019）.肥大型组患儿的不再骨折累积生存率比萎缩型组高,差异有统计学意义（P＜0.05）;中间型组患儿的不再骨折累积生存率比肥大型组高,差异无统计学意义（P＞0.05）;中间型组患儿的不再骨折累积生存率比萎缩型组高,差异有统计学意义（P=0.001）.结论 先天性胫骨假关节患儿实现胫骨假关节愈合后表现为肥大型、中间型者,其再骨折发生率比表现为萎缩型的患儿低.Objective To investigate the relationship between postoperative X-ray type in 2 years after healing of congenital pseudarthrosis of the tibia（CPT） and refracture of CPT in children.Methods A retrospective study was performed on 67 children patients with Crawford type Ⅳ CPT who were treated with combined surgeries from December 2007 to August 2012.There were 46 male and 21 female patients with37 cases with left CPT and 30 cases with right CPT.There were 12 cases with proximal tibia dysplasia,56cases with neurofibromatosis type 1.The median age when operation was 2.8 years（from 0.6 to 11.2 years）.The patients were divided into three groups,CPT with hypertrophic group,CPT with mediate group and CPT with atrophic group,on the basis of ratio of healing cross-sectional area and transition zone in pseudarthrosis.The incidence of refracture in the three groups were investigated.Results The refracture rates of three groups were 13% （5/38）,14% （3/21）,5/8,respectively.The refracture rate difference between CPT with hypertrophic group and CPT with mediate group was not statistically significant （P =0.590）.The refracture rate of CPT with atrophic group was statistically significant lower than that of CPT with hypertrophic group and CPT with mediate group （P =0.007,0.019）.In addition,the refracture-free cumulative survival rate of CPT with hypertrophic group or CPT with mediate group was higher than that of CPT with atrophic group with the statistically significant difference（both P 〈 0.05）.And the refracture-free cumulative survival rate in CPT with hypertrophic group was lower than that in CPT with mediate group,the difference was not significant （P 〉 0.05）.Conclusion After the union of CPT,patients with hypertrophic,mediate type X ray characteristic showed lower incidence of refracture than those with atrophic type.

关 键 词：胫骨骨折 假关节 儿童 手术后并发症 X线分型 

分 类 号：R726.8[医药卫生—儿科] R816.92[医药卫生—临床医学]