克氏针髓内固定治疗1岁以内先天性胫骨假关节多中心研究  

Treatment of congenital pseudarthrosis of the tibia in children aged under 1 year with Kirschner wire intramedullary fixation: a multicenter study

作　　者：刘尧喜 刘昆 徐宏文 沈先涛 郭跃明[4] 姚满叶 唐欣[6] 唐盛平[7] 康晓鹏[8] 陈顺有[9] 梅海波 Liu Yaoxi;Liu Kun;Xu Hongwen;Shen Xiantao;Guo Yueming;Yao Manye;Tang Xin;Tang Shengping;Kang Xiaopeng;Chen Shunyou;Mei Haibo(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;Guangzhou Women&Children's Medical Center,Guangzhou 511400,China;Municipal Children's Hospital,Wuhan 430015,China;Foshan Traditional Chinese Medicine Hospital,Foshan 528099,China;Henan Children's Hospital,Zhengzhou 450006,China;Affiliated Union Hospital,Huazhong University of Science&Technology,Wuhan 430022,China;Municipal Children's Hospital,Shenzhen 518000,China;Kunming Children's Hospital,Kunming 650000;Second Municipal Hospital,Fuzhou 350007,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 [2]广州妇女儿童医疗中心,广州511400 [3]武汉儿童医院,武汉430015 [4]佛山市中医院,佛山528099 [5]河南省儿童医院,郑州450006 [6]华中科技大学同济医学院附属协和医院,武汉430022 [7]深圳市儿童医院,深圳518000 [8]昆明市儿童医院,昆明650000 [9]福州市第二医院,福州350007

出　　处：《中华小儿外科杂志》2024年第11期1038-1042,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(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)。

摘　　要：目的探讨"克氏针髓内固定"治疗1岁以内儿童先天性胫骨假关节(CPT)患儿的临床疗效。方法收集2014年10月至2021年6月CPT多中心研究协作组采取"克氏针髓内固定"治疗的1岁以内CrawfordⅣ型44例CPT患儿的临床资料,其中男27例,女17例;左侧20例,右侧24例。平均手术年龄为6.3个月,年龄范围为2~12个月。31例伴神经纤维瘤病1型。既往均无胫骨假关节手术史。随访时评估初期愈合、胫骨成角情况,术后感染、克氏针退出、克氏针断裂并发症情况。结果所有病例均获得随访,平均随访时间为24个月,范围为12~48个月。44例中15例行闭合复位,其中7例愈合,愈合率为46%;29例切开复位患儿,其中12例愈合,愈合率为41%,二组间差异无统计学意义(P>0.05)。19例术后实现初期愈合,初期愈合率43%,愈合时间为5.8(3~11)个月。44例均获得机械轴线改善,平均术前胫骨机械轴线成角度数为26°,范围在4°~73°。平均术后胫骨机械轴线成角度数为4.5°,范围在0°~15.5°。41例患儿存在胫骨不等长,胫骨不等长发生率为93%,胫骨不等长3.1(0.5~8.6)cm。1例患儿术后发生感染,4例患儿克氏针退出,5例患儿克氏针断裂。结论应用"克氏针髓内固定"治疗1岁以内CrawfordⅣ型先天性胫骨假关节能较好地恢复胫骨机械轴线,防止断端骨萎缩和胫骨成角畸形进一步加重,为二期行联合手术提供了良好的条件。Objective:To explore the clinical efficacy of"Kirschner wire intramedullary fixation"for congenital pseudarthrosis of the tibia(CPT)in children aged under 1 year.Methods:From October 2014 to June 2021,the relevant clinical data were retrospectively reviewed for 44 children aged under 1 year with Crawford type IV CPT undergoing"Kirschner wire intramedullary fixation".There were 27 boys and 17 girls with an average operative age of 6.3(2-12)month.The involved side was left(n=20)and right(n=24).And 31 cases were accompanied with neurofibromatosis type 1.There was no previous history of CPT surgery.Initial healing,tibial angle formation,postoperative infection and Kirschner wire slipping/breakage were recorded.Results:Average follow-up period was 24(12-48)month.And 15/44 cases underwent closed reduction with a healing rate of 46%(7/15)while 12/29 cases of open reduction achieved with a healing rate of 41%.There was no statistically significant inter-group difference.Nineteen cases achieved an initial healing rate of 43%with a healing time of 5.8(3-11)month.All of them obtained mechanical axial improvement with an average preoperative tibial mechanical axis angle of 26°(4°-73°).Average postoperative tibial mechanical axis angular degree was 4.5°(0°-15.5°).And 41 cases had tibial inequality with an incidence rate of 93%and a tibial inequality of 3.1(0.5-8.6)cm.There was one case of postoperative infection.Kirschner wire slipped(n=4)and broke(n=5).Conclusion:For CrawfordⅣCPT aged under 1 year,"Kirschner wire intramedullary fixation"may effectively restore tibial mechanical axis,prevent further aggravation of bone atrophy and tibial angular deformity and provide optimal conditions for secondary combined surgery.

关 键 词：骨折固定术 髓内 多中心研究 假关节 

分 类 号：R726.8[医药卫生—儿科]