多段截骨矫形可延长髓内钉固定治疗儿童成骨不全股骨畸形  

Multiple corrective osteotomy plus intramedullary telescopic nail fixation for femoral deformity in children with osteogenesis imperfect

作　　者：郭永成[1] 呼鹏飞 董延召[1] 冯国明[1] 王飞鹏 Guo Yongcheng;Hu Pengf ei;Dong Yanzhao;Feng Guoming;Wang Feipeng(Department of Pediatric Orthopedics, Third Affiliated Hospital, Zhengzhou University, Zhengzllou 450052, Chin)

机构地区：[1]郑州大学第三附属医院骨科,450052

出　　处：《中华小儿外科杂志》2018年第3期214-218,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨多段截骨矫形可延长髓内钉内固定治疗儿童成骨不全股骨畸形的手术特点和临床效果。方法2013年1月至2016年10月采用多段截骨矫形可延长髓内钉内固定治疗成骨不全股骨畸形16例（共20根股骨）。其中男9例，女7例；年龄5～13岁，平均8.3岁；体重21.2～46.8 kg，平均31.1 kg。按照Barthel指数评分和运动功能独立性评定量表（motor Functional Independence Measure ，mFIM）评估术后疗效。结果16例患儿均获随访；随访时间为8～42个月，平均26个月。股骨截骨愈合时间为6～13周，平均8周。所有患儿均未发生再次骨折，未发生血管神经损伤、感染、骨不连等并发症，股骨畸形得到矫正和下肢功能明显改善。末次随访时，患儿Barthel指数评分由术前平均（64.38±16.82）分提高到术后平均（83.13±10.14）分，mFIM评分由术前平均（69.00±11.06）分提高到术后平均（81.88±6.17）分，手术前后比较，差异均有统计学意义（P均〈0.05）。8例术前需拐杖辅助行走患儿，可独立行走；5例术前因多次反复骨折致股骨重度畸形而卧床患儿中，2例可独立行走，3例需拄拐行走；3例术前虽可自主行走但行走100 m后需要休息患儿，术后活动范围明显改善，恢复正常行走。结论多段截骨矫形可延长髓内钉固定是治疗成骨不全儿童的股骨畸形的一种良好方法。ObjectiveTo evaluate the surgical approaches and outcomes of multiple corrective osteotomy plus intramedullary telescopic nail fixation for femoral deformity in osteogenesis imperfecta （OI） children.MethodsFrom January 2013 to October 2016, 20 femora of 16 OI patients undergoing multiple corrective osteotomy and intramedullary telescopic nail fixation. There were 9 boys and 7 girls with a mean age of 8.3 （5-13） years and a mean weight of 31.1 （21.2-46.8） kilograms. Preoperative and postoperative outcomes were evaluated by Barthel index and motor functional independence measure（mFIM）.ResultsThe mean follow-up period was 26 （8-42） months. And the mean time of bone healing was 8（6-13） weeks. There was no occurrence of refracture or complications. Both postoperative mobility and lower extremity function improved in all patients. The mean Barthel index improved from preoperative （64.38±16.82） points to postoperative （83.13±10.14）points at the latest follow-up. The mean mFIM score increased from preoperative（69.00±11.06）points to postoperative（81.88±6.17）points. For pre and post-operative comparisons, the difference was statistically significant （P〈0.05）. Eight of them with preoperative stick aid could walk independently after surgery; among 5 in preoperative sickbed, 2 could walk independently and the remainder did so with stick aid; 3 children needed a rest after walking autonomously for 100 meters, their range of activities improved markedly and normalized after surgery.ConclusionsMultiple corrective osteotomy plus intramedullary telescopic nail fixation is efficacious for femoral deformity in OI children.

关 键 词：成骨不全 髓内钉 截骨术 

分 类 号：R726.8[医药卫生—儿科]