儿童腓骨移植对供腿功能影响的长期随访

Long term effect on the donor site after vascularized fibular grafts in children

目的 评价儿童腓骨切除后对小腿及踝关节功能的影响。方法 自 1980年以来 ,对32例儿童作了腓骨移植术 ,其中对 13例患儿作了长期随访 ,随访最长时间为 14年 ,最短时间为 5年 ,平均随访 7年 8个月。通过患儿小腿外观、功能活动及膝、踝关节X线片检查 ,观察外踝移位情况、关节间隙及胫腓两端骨骺结构变化。结果 随访结果显示 ,10例行走运动正常 ,但长时间大运动量后感小腿及踝关节乏力 ;2例踝关节外翻 ,内踝突出 ,供腿单足站立不稳 ;1例腓骨移植 11年后 ,两小腿胫骨相差 2 .5cm。X线片结果显示 :3例外踝上移或伴有后移 ,胫骨远端骨骺呈“楔形样变” ,1例下胫腓关节分离 ;2例腓骨小头轻度下移外 ,膝关节外形活动正常 ,所有患儿未发生胫骨骨折和拇趾屈曲挛缩畸形。结论 儿童腓骨切除后对踝关节的结构有影响 ,腓骨切除位置愈低 ,影响愈大。

Objective To evaluate long term effects on the donor site in children after the fibular grafting.Methods The vascularized fibular grafting has been performed in 32 children with the bone defect since 1980.The long term follow-up was done in 13 of them. The mean observation period was 7.5 years,ranging from 5 to 14 years. The ankle function,appearance of the donor limb and morphological changes of the epiphysis were observed by physical examination and X-ray analysis.Results For clinical examination,10 cases had slight pain or discomfortable while long time running,2 cases had ankle valgus deformity and instability on solo-foot,1 case had 2.5cm discrepancy of left and right tibia .The X-ray showed that proximal or posterior migration of the lateral malleolus,tibial epiphysis wedge-like change and talar tilt were observed in the 3 cases,tibiofibular syndesmosis separation in 1 cases,distal migration of the fibula head without clinical symptom in the 2 caese.No tibia fracture and contracture of flexor hallucis longus occurred.Conclusions The resection of the fibula has detrimental effect on functions of the ankle of the donor leg in children. The lower the fibula was resected,the more profound the side effects.