胫骨近端骺板延长治疗先天性胫骨假关节术后胫骨短缩畸形  

Efficacy of proximal tibial epiphyseal plate lengthening for tibial shortening deformity after operation for congenital pseudoarthrosis of the tibia in children

作　　者：刘尧喜 刘昆 谭谦 朱光辉 赵卫华 杨戈 伍江雁 易银芝 谢永红 梅海波 Liu Yaoxi;Liu Kun;Tan Qian;Zhu Guanghui;Zhao Weihua;Yang Ge;Wu Jiangyan;Yi Yinzhi;Xie Yonghong;Mei Haibo(The Affiliated Children's Hospital of Xiangya School of Medicine,Central South University(Hunan Children's Hospital),Hunan Provincial Key Laboratory of Pediatric Orthopedics,The School of Pediatrics,University of South China,Changsha 410007,China)

机构地区：[1]中南大学湘雅医学院附属儿童医院(湖南省儿童医院),儿童骨科学湖南省重点实验室,南华大学儿科学院,长沙410007

出　　处：《中华小儿外科杂志》2024年第5期436-440,共5页Chinese Journal of Pediatric Surgery

基　　金：湖南省卫生健康委一般指导课题(D202304078395);儿童骨科学湖南省重点实验室开放课题(2023TP1019);芙蓉实验室科技项目(2023SK2111);湖南省儿童肢体畸形临床医学研究中心(2019SK4006);湖南省临床医疗技术创新引导项目(2021SK50526)。

摘　　要：目的评估儿童先天性胫骨假关节(congenital pseudarthrosis of the tibia,CPT)患儿使用伊氏外固定装置行胫骨近端骺板延长手术的愈合疗效及并发症情况。方法收集2018年6月至2021年10月湖南省儿童医院收治的因胫骨短缩而接受胫骨近端骺板延长手术的11例CPT患儿的临床资料,其中男6例,女5例。根据胫骨延长1个月后的X线片检查结果和Li分类系统评估骨痂质量。随访延长段骨痂质量及胫骨延长术后并发症情况。结果手术时患儿的平均年龄为8.8岁,平均随访时间为34.4个月,平均延长长度为6.5 cm。骨痂形态质量良好的发生率为100%,愈合指数为52.5 d/cm。伊氏外固定装置平均佩戴时间为319 d。1例发生针道感染,1例发生踝关节僵硬;1例发生胫骨延长段成角畸形,1例踝关节跖屈20°畸形,1例膝关节活动受限,2例发生踝外翻。结论胫骨近端骺板延长手术成骨质量良好,CPT伴有胫骨短缩的患儿应根据具体情况选择胫骨延长手术。ObjectiveTo evaluate the healing efficacy and complications of proximal tibial epiphyseal plate lengthening with Ilizarov external fixation device in children with congenital pseudarthrosis of the tibia(CPT).MethodsFrom June 2018 to October 2021,the relevant clinical data were retrospectively reviewed for 11 CPT children undergoing proximal epiphyseal plate lengthening surgery for tibial shortening.There were 6 boys and 5 girls.Based upon the radiographic results at Month 1 post-operation,callus quality was evaluated according to the Li classification.Quality of callus in extended segment and complications were followed up.ResultsAverage operative age was 8.8 years,average follow-up period 34.4 months and average length of extension 6.5 cm.The incidence of decent callus morphological quality was 100%,healing index 52.5 d/cm and average fixation time of external fixation device 319 days.There were needle tract infection(n=1)and ankle stiffness(n=1).The outcomes were tibial extension angulation deformity(n=1),ankle plantar flexion 20°deformity(n=1),knee joint mobility restriction(n=1)and ankle valgus(n=2).ConclusionThe osteogenic quality of proximal tibial epiphyseal plate lengthening is excellent.For CPT children with tibial shortening,tibial lengthening should be customized according to specific situations.

关 键 词：胫骨 骺板 先天性胫骨假关节 骨痂 儿童 

分 类 号：R726.8[医药卫生—儿科]