先天性胫骨假关节的手术治疗

Operative treatment of congenital pseudarthrosis of tibia

目的探讨先天性胫骨假关节的手术方式及疗效。方法对自1994年1月-2008年1月收治的先天性胫骨假关节7例,彻底切除假关节部位异常骨组织和增生的纤维结缔组织,钻通骨髓腔,创建新鲜的骨折断端。植骨方法分别为带血管蒂的腓骨移植或自体髂骨移植。固定方法采用髓内钉或Ilizarov外固定架固定,结合石膏及支具外固定。结果随访2～11年,5例骨折最终愈合,此5例中一次手术骨愈合3例,再骨折2例3次。失败2例,其中1例报告植骨Ilizarov外固定失败后,拒绝再治疗。另1例双侧胫腓假关节患儿,随访11年,共行5次髓内针内固定,3次Ilizarov外固定,均失败,患儿已14岁,轮椅生活,拒绝截肢。结论目前先天性胫骨假关节的治疗效果仍是不够理想,彻底切除病变组织带血管蒂的腓骨移植结合Ilizarov外固定或可提高治愈率。

Objective To explore the surgical procedure and curative effects for congenital pseudarthrosis of the tibia （CPT）. Methods 7 cases with CPT underwent surgical treatment from January 1994 to January 2008. The invovlved limb was treated with auto bone grafts of ilium or a free vascularised fibular graft, and fixed by intramedullary nail or Ilizarov external fixation after the pseudarthrosis site resection. Results The follow-up time was ranged from 2-11 years. Five patients experienced final union, of whom two were suffering re-fracture. In two patients with nonunion, one with bilateral involvement underwent operations with intramedullary nail for five times and Ilizarov external fixation for three times but the patient refused amputation. Conclusion The therapeutic method of CPT is still a challenge, and Ilizarov method combined with the vascularised fibular graft might be a good choice.