髓内棒固定对先天性胫骨假关节患儿骺板骨桥发生的影响  

Occurrences and influencing factors of physeal bone bridge after intramedullary rod transphyseal fixation in children with congenital pseudarthrosis of tibia

作　　者：许思宇 梅海波[1] 朱光辉[1] 刘昆[1] 谭谦[1] 严安[1] 肖汉 仇君[1] 简书浪 蔡毅 Xu Siyu;Mei Haibo;Zhu Guanghui;Liu Kun;Tan Qian;Yan An;Xiao Han;Qiu Jun;Jian Shulang;Cai Yi(Department of Orthopedics,Hunan Children's Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院骨科,长沙410007

出　　处：《中华小儿外科杂志》2024年第1期57-64,共8页Chinese Journal of Pediatric Surgery

基　　金：湖南省重点研发计划(2020SK2113)。

摘　　要：目的研究先天性胫骨假关节(congenital pseudarthrosis of tibia,CPT)患儿通过髓内棒经骺板固定治疗后,胫骨远端骺板骨桥的发生情况和影响因素。方法回顾性分析2011年9月至2020年12月收治于湖南省儿童医院骨科的209例采用髓内棒固定治疗的CPT患儿临床资料,其中男133例,女76例;手术时年龄为(3.8±2.6)岁,范围在1.0~14.7岁。术后随访(4.7±2.2)年,定期复查X线片观察患儿是否发生骨桥,根据末次随访时是否发生骨桥将患儿分为骨桥组(13例)和无骨桥组(196例),比较两组患儿术前、术中及术后随访的观察指标,通过单因素分析和倾向性评分匹配探究骨桥发生的影响因素。结果患儿骨桥发生率为6.2%(13/209),骨桥发生中位时间为11.0(7.0,14.5)个月,范围在术后2.0~17.0个月。两组患儿髓内棒固定的次数比较,差异有统计学意义(P=0.014),即髓内棒固定累计次数≥3次时,CPT患儿术后骨桥发生的可能性较<3次者高。其余观察指标在两组患儿中差异无统计学意义(均P>0.05),进一步行倾向性评分匹配后未发现其他影响骨桥发生的因素。结论CPT患儿髓内棒固定术后骨桥发生率低,髓内棒固定累计次数是术后骨桥发生的影响因素。Objective To explore the occurrence of bone bridge after intramedullary rod transphyseal fixation in children with congenital pseudarthrosis of tibia(CPT).Methods From September 2011 to December 2020,the relevant clinical data were retrospectively reviewed for 209 CPT patients undergoing intramedullary rod transphyseal fixation.There were 133 boys and 76 girls with a median operative age of(1.0-4.7)(3.8±2.6)years.According to the follow-up results,they were assigned into two groups of bone bridge and none bone bridge.Various influencing factors of bone bridge generation were explored through single-factor analysis.Results The incidence of bone bridges was 6.2%(13/209).During an average follow-up period of(4.7±2.2)years,the median occurring time of postoperative bone bridge was 11.0(7.0,14.5)months with a range of(2.0-17.0)months.Significant inter-group statistical difference existed in cumulative operative duration(P=0.014).Bone bridge occurred more frequently in≥3 times of cumulative operative duration than that of<3 times.No significant inter-group differences existed in other observation parameters or propensity score matching results(P>0.05).Conclusions In CPT children undergoing intramedullary rod transphyseal fixation,the postoperative incidence of bone bridge is around 6.2%.Patients with CPT operated over twice have a higher possibility of physeal bone bridge formation at distal tibia than those less than thrice.

关 键 词：假关节 先天性胫骨假关节 骺板 

分 类 号：R726.8[医药卫生—儿科]