骨牵引针联合Ilizarov外固定架治疗先天性胫骨假关节术后再骨折的危险因素分析  

Risk factors related to refracture after union of congenital pseudarthrosis of the tibia with a combined surgical

作　　者：邓华军 梅海波[2] 赵伟 

机构地区：[1]柳州市妇幼保健院骨科,545001 [2]湖南省儿童医院骨科,长沙410007

出　　处：《中华骨科杂志》2018年第3期164-171,共8页Chinese Journal of Orthopaedics

摘　　要：目的 探讨先天性胫骨假关节骨牵引针联合Ilizarov外固定术后再骨折的危险因素。方法 回顾性分析2007年4月至2011年8月确诊为先天性胫骨假关节且采用骨牵引针联合Ilizarov外固定术后获得骨性愈合的患儿40例,男27例,女13例;年龄0.8~11.3岁,平均（3.6±2.7）岁。随访时间〉36个月。分别对性别、是否合并Ⅰ型神经纤维瘤病（neurofibromatosis type 1,NF-1）、手术时年龄、腓骨状态、踝关节状态、假关节愈合处横截面积相对比进行单因素无骨折生存分析,对有统计学意义的单因素进行多因素Cox比例风险回归分析,从而得到导致再骨折的危险因素。结果 不同性别、是否合并NF-1的患儿无骨折生存率的组间差异无统计学意义。手术时年龄≥3岁者平均无骨折生存时间及中位无骨折生存时间长于年龄〈3岁者,其无骨折生存率差异有统计学意义。腓骨完整或远端融合、固定者平均无骨折生存时间及中位无骨折生存时间长于腓骨假关节者,其无骨折生存率差异有统计学意义。踝关节固定者平均无骨折生存时间及中位无骨折生存时间长于踝关节未固定者,其无骨折生存率差异有统计学意义。假关节愈合处横截面积相对比〈0.15者平均无骨折生存时间及中位无骨折生存时间长于相对比≥0.15者,两者无骨折生存率差异有统计学意义。Cox比例风险回归分析显示假关节愈合处横截面积相对比与再骨折呈负相关（β=-1.989,P〈0.05）,腓骨状态与再骨折呈正相关（β=1.506,P〈0.05）,手术时年龄、踝关节状态与再骨折无关（P〉0.05）。结论 采用联合手术治疗先天性胫骨假关节,导致术后再骨折的主要风险因素为较小的假关节愈合处横截面积和伴有腓骨假关节。Objective To explore the risk factors related to refracture after union of congenital pseudarthrosis of the tibia with a combined surgical, and to provide an important reference for clinical treatment. Methods From April 2007 to August 2011, 40 cases of congenital pseudarthrosis of the tibia （CPT） confirmed by the use of intramedullary nail combined Ilizarov external fixator treatment of bony union were obtained for retrospective analysis. There were 27 males and 13 females, and the average age was 3.6±2.7 years （ranged from 0.8 to 11.3 years）, and the follow-up time are all over 36 months. Survival analysis were applied respectively on gender, whether the merger of neurofibromatosis type 1 （NF-1） and ankle joint, operative age, fibular status and the cross-sectional area ratio of healing site. Multifactorial Cox proportional hazards regression analysis was performed on the single factor with statistical significance. Results No significant inter-group differences existed in gender or whether combined NF-1. In operative age ≥3 years group whose refracture-free survival was significantly better than those 〈3 years. Intact fibula or stabilised by tibiofibular synotosis or Kirschner wire group showed significantly better refracture-free survival than those with a pseudarthrotic fibula due to neglect or failed synostosis. There was significant difference between ankle joint fixed group and ankle joint unfixed group in mean refracture-free period. With a cross-sectional area median ratio of healing site of 0.15, refracture-free survival was better than those with a lesser value, and the difference was statistical significant. Cox proportional hazards regression analysis showed a negative correlation between the cross-sectional area and the refracture occurred （β=-1.989, P〈0.05）, fibular pseudarthrosis and refracture occurred were positively correlated （β=1.506, P〈0.05）, operative age and ankle joint status had no relationship with refracture occurred （P〉0.05）. Conclusion The major

关 键 词：假关节 胫骨 骨折固定术 危险因素 

分 类 号：R726.8[医药卫生—儿科]