内外固定联合骨移植术治疗先天性胫骨假关节10例临床分析  

Internal fixation and external fixator combined with bone transplantation for treatment of congenital pseudarthrosis of tibia

作　　者：申守仁 明新月[1] 明新武[1] 高卫原 高积看 常彩虹[1] 明立功 SHEN Shouren;MING Xinyue;MING Xinwu;GAO Weiyuan;GAO Jikan;CHANG Caihong;MING Ligong(Department of Children's Orthopedics,Huaxian Orthopedic Hospital,Anyang,Henan 456485,China;不详)

机构地区：[1]滑县骨科医院儿童骨科,河南安阳456485 [2]滑县新区医院骨科,河南安阳456000

出　　处：《中国骨与关节损伤杂志》2025年第2期137-140,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的观察Ilizarov技术、斯氏针髓内固定联合骨移植术治疗先天性胫骨假关节的临床疗效。方法回顾性分析自2011-08—2021-12诊治的10例先天性胫骨假关节,BoydⅡ型6例,BoydⅤ型4例。术中切除假关节及病变骨膜,取自体带3层皮质髂骨块置入胫腓骨之间行胫腓骨融合,斯氏针髓内固定、Ilizarov外固定架加压固定,胫骨短缩待假关节愈合后二期行胫骨近端干骺端截骨延长术。参照Richards等改良胫骨干骨折愈合的影像学评分系统评估假关节愈合结果,末次随访时临床疗效按Johnston临床分期标准评价。结果10例均获得随访,随访时间10~48个月,平均24个月。胫骨假关节全部临床愈合,愈合时间4.3~10.5个月,平均8.1个月。参照Richards等的标准,假关节愈合7例,假关节延迟愈合3例。术后2例患肢短缩1 cm,不影响行走,未行肢体延长术;8例胫骨短缩患儿二期行胫骨延长术。术后胫骨假关节愈合处横截面积增宽,末次随访时未再骨折。3例踝关节活动度正常,3例踝关节外翻畸形,4例踝关节处于中立位。末次随访时临床疗效按Johnston临床分期标准评价:Ⅰ级8例,Ⅱ级2例。结论采用Ilizarov技术、斯氏针髓内固定联合骨移植术治疗先天性胫骨假关节可以取得满意疗效,假关节处横截面积明显增加,提高了假关节愈合率,降低了再骨折风险。ObjectiveTo observe the clinical efficacy of Ilizarov technique,Kirschner wire intramedullary fixation combined with bone transplantation in the treatment of congenital pseudarthrosis of the tibia.MethodsA retrospective analysis was conducted on 10 cases of congenital tibial pseudarthrosis treated from August 2011 to December 2021,including 6 cases of Boyd typeⅡand 4 cases of Boyd type V.During the operation,the pseudarthrosis and diseased periosteum were removed,and autologous cortical iliac bone blocks with 3 layers were placed between the tibia and fibula for tibiofibular fusion.The tibia was then fixed with a Kirschner wire intramedullary fixation and an Ilizarov external fixation frame under compression.After the pseudarthrosis healed,a second stage proximal tibial metaphyseal osteotomy and lengthening surgery was performed.Referring to Richards's improved imaging scoring system for tibial shaft fracture healing,the results of pseudarthrosis healing were evaluated.At the last follow-up,clinical efficacy was evaluated according to the Johnston clinical staging criteria.ResultsAll 10 cases were followed up for 10-48 months,with an average of 24 months.All tibial pseudarthrosis clinically healed,with a healing time of4.3-10.5 months,with an average of 8.1 months.According to Richards's standard,there were 7 cases of prosthetic joint healing and 3 cases of delayed prosthetic joint healing.In two cases limb shortening by 1 cm after surgery did not affect walking,and limb lengthening surgery was not performed;Eight children with tibial shortening underwent secondary tibial lengthening surgery.The cross-sectional area of the tibial pseudarthrosis site widened after surgery,and there were no further fractures at the last follow-up.Three cases had normal ankle range of motion,three cases had eversion deformity,and four cases had ankle joint in neutral position.At the last follow-up,the clinical efficacy was evaluated according to the Johnston clinical staging criteria:8cases were classified as grade I and 2 cases a

关 键 词：先天性胫骨假关节 ILIZAROV技术 髓内固定 外固定架 骨移植术 

分 类 号：R687.3[医药卫生—骨科学]