胫骨近端骺板延长和骺板下延长治疗先天性胫骨假关节胫骨短缩的临床研究

Treatment of congenital pseudarthrosis of the tibia with proximal tibial epiphyseal plate extension and subphyseal plate extension

目的评估儿童先天性胫骨假关节(congenital pseudarthrosis of the tibia,CPT)患者使用伊氏外固定装置行胫骨近端骺板下延长术和胫骨近端骺板延长术的愈合及并发症情况。方法回顾性分析湖南省儿童医院2012年2月至2020年6月间使用伊氏外固定装置行胫骨延长手术的61例CPT患儿临床资料。根据手术方式分组,行胫骨近端骺板下延长术者为A组(n=54),行胫骨近端骺板延长术者为B组(n=7)。选取延长后第1个月的X线片检查结果,采用Li分型评估骨痂质量。随访延长段骨痂质量及胫骨延长术后并发症情况。结果A组与B组手术时年龄[(87.0±5.9)个月比(115.2±15.2)个月]、延长长度[(5.3±0.2)cm比(7.0±1.6)cm]、愈合指数[(57.3±3.6)d/cm比(50.4±7.4)d/cm]比较,差异均无统计学意义(P>0.05);两组骨痂质量良好率(37/54比7/7)比较,差异无统计学意义(P=0.088);两组并发症发生率比较,针道感染(4/54比1/7)、胫骨机械轴线偏移(4/54比1/7)、腓骨提前愈合(3/54比0/7)、踝关节僵硬(2/54比1/7)、膝关节活动范围减小(7/54比1/7)的差异均无统计学意义(P>0.05)。结论胫骨近端骺板延长术与胫骨近端骺板下延长术均为CPT伴胫骨短缩的有效治疗方法,但胫骨近端骺板下延长存在腓骨提前愈合等并发症。

Objective To evaluate the healing status and complications of proximal tibial epiphyseal plate lengthening using Ilizarov external fixation device in children with congenital pseudarthrosis of the tibia(CPT).Methods Retrospective analysis was conducted for clinical data of 61 CPT children undergoing tibial lengthening surgery using Ilizarov external fixation device from February 2012 to June 2020.According to surgical method,they were assigned into two groups of A and B.Radiographic examination results of the first month after extension were utilized for evaluating the quality of bone callus by the Li classification scheme.Follow-ups were conducted for the quality of bone callus in extended segment and postoperative complications.Results No statistically significant inter-group difference(P>0.05)existed in operative age[(87.0±5.9)vs.(115.2±15.2)month],length of extension[(5.3±0.2)vs.(7.0±1.6)cm]or healing index[(57.3±3.6)vs.(50.4±7.4)d/cm].There was no statistically significant inter-group difference(P>0.05)in rate of good callus quality(37/54 vs.7/7).No statistically significant inter-group difference(P=0.088)existed in the incidence of complications or needle infection(4/54 vs.1/7).No statistically significant differences existed(P>0.05)in deviation of tibial mechanical axis(4/54 vs.1/7),early healing of fibula(3/54 vs.0/7),ankle Joint stiffness(2/54 vs.1/7)or reduction of knee range of motion(7/54 vs.1/7).Conclusions Both proximal tibial epiphyseal plate elongation and proximal tibial epiphyseal plate elongation are efficacious for CPT.And early fibular healing may occur in the extension of proximal tibial epiphyseal plate.