儿童先天性胫骨假关节行不同术式疗效的多中心临床研究  

A multicenter clinical trial on the efficacy of different surgical procedures for congenital pseudarthrosis of tibia in children

作　　者：刘尧喜 张学军[2] 郭跃明[3] 徐宏文 李进[5] 蒋飞[6] 梅海波[1] Liu Yaoxi;Zhang Xuejun;Guo Yueming;Xu Hongwen;Li Jin;Jiang Fei;Mei Haibo(Department of Pediatric Orthopedics,Hunan Children's Hospital,Changsha 410007,China;Department of Pediatric Orthopedics,Beijin Children's Hospital,Beijing 100045,China;Department of Pediatric Orthopedics,Foshan Hospital of Tradition Chinese Medicine,Foshan 528000,China;Department of Pediatric Orthopedics,Guangzhou Women&Children's Medical Center,Guangzhou 510000,China;Department of Pediatric Orthopedics,Union Hospital of Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430022,China;Department of Pediatric Orthopedics,Municipal Children's Hospital,Dalian,Dalian 116012,China)

机构地区：[1]湖南省儿童医院骨科,长沙410007 [2]北京儿童医院骨科,100045 [3]佛山市中医院小儿骨科,528000 [4]广州市妇女儿童医疗中心骨科,510000 [5]华中科技大学同济医学院附属协和医院骨科,武汉430022 [6]大连市儿童医院骨科,116012

出　　处：《中华小儿外科杂志》2020年第10期933-937,共5页Chinese Journal of Pediatric Surgery

基　　金：福棠儿童科学基金(FTCSF-2018-02);国家重点研发计划(2018YFC1002503);湖南省出生缺陷协同防治科技重大专项(2019SK1010);湖南省儿童肢体畸形临床医学研究中心(2019SK4006)。

摘　　要：目的回顾性分析多中心儿童先天性胫骨假关节(congenital pseudarthrosis of the tibia,CPT)行不同手术方式后的愈合情况。方法收集多中心自2007年7月至2019年9月应用手术治疗的CPT患儿429例。其中,男277例,女152例;CPT CrawfordⅣ型408例,CrawfordⅢ型21例;左侧209例,右侧214例,双侧6例;294例患儿伴神经纤维瘤病Ⅰ型(neurofibromatosis typeⅠ,NF-1);胫骨假关节位于上1/3者16例,中下1/3者413例。平均手术时年龄为8岁,范围为0.8~13.4岁;患儿首次骨折的平均年龄为3.3岁,本研究中最早骨折的年龄为出生时,首次骨折的最晚年龄为12岁。本研究按手术方式可分为包裹式植骨联合手术(329例)、弹性髓内针(13例)、伊氏架+弹性髓内针(32例)、伊氏架(18例)、钢板(28例)、单臂外固定(4例)、克氏针(3例)、伊氏架+髓内棒(2例)。收集术后随访胫骨假关节患儿的初期愈合情况。结果330例CPT患儿实现初期愈合,平均愈合时间为4.5个月,范围为3.0~8.5个月)。包裹式植骨联合手术治疗较单纯运用钢板、伊氏架联合弹性髓内针治疗的初期愈合率高,整体差异具有统计学意义(P<0.05)。采用卡方分割法(显著性水准调整为0.05/3=0.017)进行两两比较,包裹式植骨联合手术与弹性髓内针愈合率的差异有统计学意义(P<0.001),包裹式植骨联合手术与伊氏架+弹性髓内针愈合率的差异有统计学意义(P<0.001),包裹式植骨联合手术与伊氏架愈合率的差异也具有统计学意义(P<0.001),弹性髓内针与伊氏架+弹性髓内针愈合率的差异则没有统计学意义(P=0.203)。结论包裹式植骨联合手术是治疗CPT的一种有效方法,初期愈合率高。单纯运用伊氏架、钢板、弹性髓内针、克氏针等治疗的患儿初期愈合率低,常需要再次手术治疗。Objective To explore the healing rate of congenital pseudarthrosis of tibia (congenital pseudarthrosis of tibia, CPT) after different surgical approaches.Methods A total of 429 CPT children underwent surgical procedures from July 2007 to September 2019. There were 277 boys and 152 girls. The Crawford classification types were Ⅳ (n=408) and Ⅲ (n=21). The involved side was left (n=209), right (n=214) and bilateral (n=6). And 294 cases belonged to neurofibromatosis type I (NF-1). The lesions were located in upper 1/3 of tibia (n=16) and middle/lower 1/3 (n=413). The average operative age was 8(0.8-13.4) years and the average age of initial fracture 3.3 years. The earliest age of fracture was at birth and the latest age of initial fracture was 12 years. Based upon operative approaches, there were combined operation (n=329), elastic intramedullary nail (n=13), IIizarov's fixator plus elastic intramedullary nail (n=32), IIizarov's fixator (n=18), steel plate (n=28), single arm external fixation (n=4), Kirschner wire (n=3) and IIizarov's fixator plus intramedullary rod (n=2). The initial healing profiles of children with pseudarthrosis of tibia were followed up.Results A total of 330 CPT cases achieved initial healing. The average healing time was 4.5(3.0-8.5) months. The initial healing rate of combined operation was higher than that of simple procedure (P<0.05). Chi-square analysis (significance level adjusted to 0.05/3=0.017) was employed for comparing the healing rate of two surgical approaches. The difference was statistically significant between combined operation and elastic intramedullary needle (P<0.001) and combined operation and IIizarov's fixator plus elastic intramedullary needle (P<0.001). Significant difference existed in healing rate between combined operation and IIizarov's fixator (P<0.001). However, no significant difference existed between elastic intramedullary needle and IIizarov's fixator plus elastic intramedullary needle (P=0.203).Conclusions Combined operation is an effective treatment of c

关 键 词：多中心研究 先天性胫骨假关节 手术方式 

分 类 号：R726.8[医药卫生—儿科]