胫腓骨Cross-union内固定法治疗儿童先天性胫骨假关节的临床研究  

Combination treatment by cross union of tibia and fibula for congenital pseudarthrosis of the tibia in children

作　　者：吴春星[1] 莫越强[1] 王达辉[1] 宁波[1] Wu Chunxing;Mo Yueqiang;Wang Dahui;Ning Bo(Department of Pediatric Orthopedics,Children's Hospital of Fudan University,National Children's Medical Center.Shanghai 201102,China)

机构地区：[1]国家儿童医学中心,复旦大学附属儿科医院儿骨科,上海201102

出　　处：《中华小儿外科杂志》2023年第9期834-840,共7页Chinese Journal of Pediatric Surgery

基　　金：上海市科学技术委员会上海市2020年度"科技创新行动计划"医学创新研究专项项目(20Y11912900)。

摘　　要：目的评估胫腓骨Cross-union内固定法治疗儿童先天性胫骨假关节的临床效果。方法收集2018年10月至2021年11月采用胫腓骨Cross-union内固定法治疗的10例先天性胫骨假关节患儿的临床资料,其中男6例,女4例,平均手术年龄5.5岁,范围为2.4~13.3岁,患侧为左侧5例,右侧5例。首次手术5例,既往手术史出现再骨折5例。总结分析先天性胫骨假关节初期骨愈合、再骨折发生率、胫骨不等长以及膝、踝内外翻等情况。结果所有患儿均获得完整随访,平均随访时间20个月,范围为3.9~41.2个月,均实现初期骨愈合,平均愈合时间为3.4个月(2.9~4.2个月)。5例患儿存在胫骨不等长,其中3例不等长大于4 cm,需要后续治疗;2例患儿存在残余踝外翻(均为多次手术史,本手术方法前已存在踝外翻);无患儿出现新发膝、踝内外翻。术后胫骨假关节愈合区域的横断面积平均增大至胫骨近端面积的0.46(0.28~0.71)、胫骨远近端面积平均值的0.57(0.39~0.84)。10例患儿均未发生再骨折,均无疼痛,7例可正常行走,3例跛行(均为多次手术史,术前已存在明显下肢不等长,术后残余下肢不等长)。结论胫腓骨Cross-union内固定法是治疗儿童先天性胫骨假关节的有效方法,能够实现初期骨愈合和维持骨愈合,有效避免假关节不愈合和再骨折的发生。Objective To evaluate the combination treatment by cross union of tibia and fibula autogenic iliac bone grafting,internal fixation and bone morphogenetic proteins in achieving union and preventing refracture for children with unilateral congenital pseudarthrosis of the tibia(CPT).Methods From October 2018 to November 2021,10 CPT children received combination treatment by cross union of tibia and fibula.There were 6 boys and 4 girls with a mean operative age of 5.5(2.4-13.3)years.The involved side was left(n=5)and right(n=5).Five cases were operated for the first time while another 5 cases re-operated for refracture.Bone union rate,refracture frenquency joint deformity and limb-length discrepancy(LLD)were assessed during follow-ups.Results The mean follow-up period was 20(3.9-41.2)months.All cases healed at the site of pseudarthrosis.The average time to achieve radiological bone union of pseudarthrosis postoperatively was 3.4(2.9-4.2)months.Five(11.1%)cases developed LLD and 3 children of>4 cm LLD required subsequent therapy.Two cases had residual ankle valgus due to a history of multiple operations and previous ankle valgus.There was no reccurrence knee/ankle deformity.The mean cross-sectional area of tibial pseudarthrosis healing area spiked to 0.46(0.28-0.71)for proximal tibia and 0.57(0.39-0.84)for proximal and distal tibia.There was no refracture or pain.Seven cases could move actively and 3 cases of claudication had a history of multiple operations,and obvious preoperative LLD.Conclusions Combination treatment by cross union of tibia and fibula is effective and safe for treating CPT children.It may obtain 100%healing without refracture.

关 键 词：胫骨 儿童 先天性胫骨假关节 内固定 再骨折 

分 类 号：R726.8[医药卫生—儿科]