新型U型钉半骨骺阻滞术治疗Ⅰ型神经纤维瘤病儿童胫骨前外侧成角畸形的短期临床疗效评价

Evaluation of short-term clinical efficacy of a novel U-nail semi-epiphyseal block for anterolateral tibial angulation deformity in children with type Ⅰ neurofibromatosis

目的评价新型U型钉半骨骺阻滞治疗I型神经纤维瘤病患儿胫骨前外侧成角畸形的短期临床疗效。方法回顾性分析湖南省儿童医院2018年1月至2021年10月采用新型U型钉半骨骺阻滞术治疗Ⅰ型神经纤维瘤病患儿胫骨前外侧成角畸形的病例资料。测量手术前、取内固定时双下肢全长X线片及胫腓骨X线片上测量双侧胫骨长度差值,测量胫骨干近端轴线和胫骨干远端轴线的成角度数(胫骨骨干角),观察有无伤口感染、内固定松动、内固定断裂、胫骨骨折、骺板骨桥、伤口愈合不良、软组织激惹等并发症。评估正侧位X线片上胫骨成角矫正效果、术前术后双侧胫骨长度差异。记录内固定留置时间、畸形矫正速率。结果共15例纳入研究,男10例,女5例;左侧12例,右侧3例,合并腓骨假关节3例。手术时年龄(49.27±23.29)个月。15例均合并I型神经纤维瘤病(neurofibromatosis type 1,NF1)。所有患儿矫正效果满意,内固定留置时间为(24.13±7.26)个月。胫骨成角畸形正位X线片平均矫正速率每月(0.77±0.09)°。1例出现U型钉松动移位、切割骺板,但无骨桥形成,予以再次手术更换U型钉。无一例感染、内固定断裂、胫骨骨折、骺板骨桥、伤口愈合不良、软组织激惹等其他并发症。正位片骨干角术前(29.72±6.87)°、取内固定时为(10.58±3.79)°,两者差异有统计学意义(P<0.05)。侧位片骨干角术前(17.95±9.56)°、取内固定时为(14.29±5.49)°,两者差异具无统计学意义(P>0.05)。术前双侧胫骨长度差异(0.79±0.54)cm、术后双侧胫骨长度差异(1.39±1.91)cm以及术前、术后双侧胫骨长度差异无统计学意义(P>0.05)。结论新型U型钉半骨骺阻滞术治疗I型神经纤维瘤病患儿胫骨前外侧成角畸形,矫正速率高,损伤小,矫形效果满意,手术操作简单,能预防胫骨骨折;但远期效果仍需进一步随访。

Objective To evaluate short-term clinical efficacy of a novel U-nail semi-epiphyseal block for anterolateral tibial angulation deformity in children with type I neurofibromatosis(NF1).Methods From January 2018 to October 2021,retrospective analysis was performed for 15 children of anterolateral tibial angulation deformity with NF1 at Hunan Children's Hospital.There were 10 boys and 5 girls.The involved side was left(n=12)and right(n=3).Differential length of bilateral tibia was measured on full-length radiographs of both lower extremities and preoperative tibiofibular radiographs and at removal time of internal fixation.The number of angles between proximal axis of tibial stem and distal axis of tibial stem(tibiofibular diaphysis angle)were measured.The complications of wound infection,loosening/breakage of internal fixation,tibial fracture,bone bridging of epiphyseal plate,poor wound healing and soft tissue agitation were observed.The effects of tibial angulation correction on frontal and lateral radiographs were examined through the differences in bilateral tibial length before and after surgery.Duration of internal fixation retention and rate of deformity correction(°/month)were recorded.Results Three cases developed concurrent fibular pseudoarthrosis.Operative age was(49.27±23.29)months.All corrections were satisfactory and duration of internal fixation was(24.13±7.26)months.Average correction rate of tibial angulation deformity was(0.77±0.09)°/month.In 1 case,loose U-nail cutting epiphyseal plate was replaced by another operation.However,there was no bone bridge formation.There was no occurrence of infection,internal fixation breakage,tibial fracture,epiphyseal plate bridge,poor wound healing,soft tissue irritation or other complications.Diaphysis angle in orthopantomogram was(29.72±6.87)°preoperatively and(10.58±3.79)°at time of internal fixation and the inter-group difference was significant(P<0.05).The difference between preoperative(17.95±9.56)°and internal fixation(14.29±5.49)°was insignificant(P>0.05).The difference in bilateral tibia length was(0.79±0.54)cm preoperatively and(1.39±1.91)cm postoperatively.And insignificant difference existed in bilateral tibia length between preoperative and postoperative periods(P>0.05).Conclusions Using a novel U-shaped for congenital anterolateral tibial angulation,hemiepiphysiodesis offers high correction rate,minimal injury,satisfactory outcomes and simple handling.It may prevent tibial fracture in children.However,long-term outcomes should be verified by further follow-ups.