可延伸髓内棒联合手术治疗先天性胫骨假关节的临床对比研究  

Clinical comparison of expandable intramedullary rod plus surgery for congenital pseudarthrosis of the tibia

作　　者：刘尧喜 谭谦 刘昆 谢永红 易银芝 杨戈 黄一勇 莫莎莎 朱光辉 梅海波 Liu Yaori;Tan Qian;Liu Kun;Xie Yonghong;Yi Yinzhi;Yang Ge;Huang Yiyong;Mo Shasha;Zhu Guanghui;Mei Haibo(Department of Orthopedics,Affiliated Children's Hospital,Xiangya School of Medicine,Central South University(Hunan Children's Hospital),Hunan Provincial Key Laboratory of Pediatric Orthopedics,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)骨科,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10期930-935,共6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：目的比较新型与传统可延伸髓内棒联合手术治疗儿童先天性胫骨假关节(congenital pseudarthrosis of tibia,CPT)的临床疗效。方法回顾性分析2017年1月至2021年10月在湖南省儿童医院采用传统可延伸髓内棒联合手术(A组,22例)、新型可延伸髓内棒联合手术(B组,23例)治疗的45例CPT患儿临床资料。其中A组男17例,女5例;假关节位于左侧12例,位于右侧10例;手术时患儿平均年龄47个月,范围在24~89个月;7例伴胫骨近端发育不良,18例伴神经纤维瘤病1型,14例伴有腓骨假关节。B组男16例,女7例;假关节位于左侧12例,位于右侧11例;手术时患儿平均年龄34个月,范围在19~60个月;4例伴胫骨近端发育不良,19例伴神经纤维瘤病1型病,13例伴有腓骨假关节。比较两组CPT患儿的初期愈合情况,胫骨近端外翻、胫骨不等长、踝外翻、再骨折及髓内棒移位等并发症情况。组间比较采用卡方检验。结果所有患儿均获得随访。A组患儿平均随访2.4年,患儿初期愈合率为95%(21/22),其中1例延迟愈合;A组患儿平均愈合时间为4.7个月。14例(64%,14/22)存在胫骨不等长,平均相差1.5 cm。6例(27%,6/22)发生胫骨近端外翻,平均外翻角度为7°;10例(45%,10/22)发生踝外翻,平均外翻角度为14.9°。17例(77%,17/22)发生髓内棒移位。9例(41%,9/22)发生再骨折。B组平均随访2.3年,患儿初期愈合率为96%(22/23),其中1例延迟愈合;B组患儿平均愈合时间4.7个月。14例(61%,14/23)存在胫骨不等长,平均相差1.0 cm。9例(39%,9/23)发生胫骨近端外翻,平均外翻角度为8.3°;7例(30%,7/23)发生踝外翻,平均外翻角度为12.3°。14例(61%,14/23)发生髓内棒移位。3例(13%,3/23)发生再骨折。A组的再骨折发生率(41%)比B组(13%)高,差异有统计学意义(P=0.030)。结论新型可延伸髓内棒联合手术与传统可延伸髓内棒联合手术比较,前者治疗CPT术后2.3年再骨折发生率低,疗效及其他并发症发生情况相当。Objective To compare the clinical efficacy of novel versus traditional extendable intramedullary rods for congenital pseudarthrosis of the tibia(CPT)in children.Methods From January 2017 to October 2021,retrospective review was conducted for the relevant clinical data of 45 CPT children undergoing traditional extendable intramedullary rod plus surgery(Group A,n=22)and novel extendable intramedullary rod plus surgery(Group B,n=23).There were 17 boys and 5 girls in Group A.Pseudarthsis was located at left side(n=12)and right side(n=10).Average operative age was 47(24-89)month.Concurrent conditions included proximal tibial dysplasia(n=7),neurofibromatosis type 1(n=18)and fibular pseudarthrosis(n=14).There were 16 boys and 7 girls in Group B.Pseudarthsis was located at left side(n=12)and right side(n=11).Average operative age was 34(19-60)month.Concurrent conditions included proximal tibial dysplasia(n=4),neurofibromatosis type 1(n=19)and fibular pseudarthrosis(n=13).Initial healing status of two groups were compared with regards to such complications as proximal tibial valgus,tibial length,ankle valgus,refracture and intramedullary rod displacement.Inter-group comparison was made with Chi-square test.Results Average follow-up period of Group A was 2.4 years.Primary healing rate was 95%(21/22)and there was 1 case of delayed healing.Average healing time of Group A was 4.7 months.Tibial dysplasia(64%,14/22)occurred with an average difference of 1.5 cm,proximal tibial valgus(27%,6/22)had an average angle of 7°,ankle valgus(45%,10/22)had an average angle of 14.9°,intramedullary rod displacement(77%,17/22)and refracture(41%,9/22).Average follow-up period of Group B was 2.3 years.Initial healing rate was 96%(22/23)and there was 1 case of delayed healing.Average healing time of Group B was 4.7 months.Tibial dysplasia(61%,14/23)occurred with an average difference of 1.0 cm,proximal tibial valgus(39%,9/23)had an average angle of 8.3°,ankle valgus(30%,7/23)had an average angle of 12.3°,intramedullary rod displacement(61%,1

关 键 词：假关节 先天性胫骨假关节 内固定 儿童 

分 类 号：R726.8[医药卫生—儿科]