胫骨远端骨骺早闭继发畸形的个体化矫形

Individualized correction for the secondary deformity after premature partial closure of epiphysis of distal tibia

目的探讨儿童胫骨远端骨骺早闭继发畸形个体化矫形的疗效。方法回顾性分析2008年1月至2016年5月西安交通大学附属红会医院收治的30例胫骨远端骨骺早闭继发患肢踝关节成角伴或不伴肢体短缩畸形患儿的临床资料。根据不同畸形情况选择个体化治疗方案,19例患儿接受骨桥切除、胫腓骨远端截骨矫形组合式外固定架固定,骨桥切除后采用自体脂肪填充骨骺开放区;其余11例患儿因骨桥面积大于或等于正常骺板的50%,故接受胫腓骨远端截骨矫形,若合并肢体短缩≥3 cm行胫腓骨近端截骨外固定延长术,不予以骨桥切除。结果 30例患儿中,28例患儿术后获得12～36个月(平均18个月)的随访,其余2例患儿术后3个月拆除外固定架后失访(均接受骨桥切除术,男女各1例)。末次随访时21例患者获得外观及功能上的改善。其中16例效果满意,矫形未丢失;9例矫形部分丢失;3例因术后骨桥再次形成,出现明显内翻畸形。以Maryland足功能评分标准评估预后:优16例,良5例,可5例,差2例,优良率为75.0%。结论骨骺早闭导致的肢体畸形复杂多样,应根据具体畸形原因和特点选用适当的矫形治疗方案。对于骨桥面积小于正常骺板50%的患儿,采用骨桥切除、自体脂肪填充联合胫腓骨远端截骨矫形治疗效果显著。当骨桥部分闭合时,其面积越大,复发率也会越高。选择合适的骨骺开放时机联合Ilizarov技术在下肢骨骺早闭所致畸形手术中的灵活应用,有助于胫骨远端复合畸形的综合矫形治疗。

Objective To investigate the curative effect of individualized correction for the secondary deformity after premature partial closure of epiphysis of distal tibia in children. Methods From January 2008 to May 2016, retrospective analysis of 30 cases of ankle joint angulation with or without limb shortening secon-dary to early epiphyseal closure of the distal tibia in Honghui Hospiteil of Xi＇ an Jiao Tong University. We selec-ted the individual treatment options according to the different malformation conditions, 19 cases received the bone bridge resection with autologous fat filling, distal tibia and fibula osteotomy combined with external fixa-tion. The bone bridge area was more than or equal 50% of normal epiphyseal plate in the other 11 cases, re-ceived the distal tibia and fibula osteotomy, and if the limb was combining with more than 3 cm shortening, re-ceived the proximal tibia osteotomy and external fixation lengthening, without bone bridge resection. Results Of the 30 cases, 28 cases were followed up 12-36 months （ average 18 months） , the other 2 cases lost to follow-up after the removal of the external fixator （both of them received the bone bridge resection, one male and one female）. At the final follow-up, there was a satisfactory improvement of the appearance and function in 21 cases. Among the 28 cases, 16 cases were satisfied with the correction, 9 cases were lost part of the correction, and 3 cases had a significant varus because of the reformation of the bone bridge. Assessment of prognosis according to the Maryland foot function score, 16 cases were excellent, 5 cases were good, 5 cases were fair, and 2 cases were poor. The rate of excellent and good was 78.5%. Conclusion The deformity after premature partial closure of epiphysis in the limb is complex and varied. Different orthopedic methods should be adopted according to the specific causes and characteristics of deformity. The bone bridge area less than 50% of normal epiphyseal plate were treated with bone bridge resection combined with autologous fat filling of distal tibia and fibula osteotomy and remarkable curative effect. The greater size of the bone bridge area when the bone bridge is partially closed, the higher rate of recurrence to it. Choosing a suitable chance of bar resection and combining with the technique of Ilizarov, it will be helpful for the comprehensive correction of complex deformity of the distal tibia.