多段截骨带锁髓内针固定治疗大龄儿童低磷酸血症佝偻病所致下肢畸形

Efficacies of multilevel osteotomy plus rigid intramedullary nail fixation for correcting deformity in elder children with X-linked hypophosphatemic rickets

目的探讨采用多段截骨带锁髓内针固定的方法治疗低磷酸血症佝偻病所致骨性畸形的效果及影响因素。方法回顾性分析2007年8月至2016年12月间收治的17例低磷酸血症佝偻病患儿的临床资料。其中,男5例,女12例;患儿第一次手术时的年龄范围为11岁1个月至15岁3个月,平均12岁9个月;所有患儿均为双下肢力线异常,28侧肢体为内翻畸形,6侧肢体为外翻畸形。结果本组17例共接受55例次手术,其中包括16例截骨股骨顺行髓内钉固定术,6例截骨股骨逆行髓内针固定术,17例截骨胫骨带锁髓内针内固定术。最终接受带锁髓内针固定治疗的肢体共26侧,有5侧为膝外翻,21侧为膝内翻。所有17例患儿均得到随访,随访时间14~96个月,平均40.5个月;患儿截骨端在4~9个月达到骨性愈合(平均6.3个月),恢复正常负重行走。未出现感染、血管神经并发症及不愈合。术后随访下肢力线最终位于1区的有9侧肢体,2区有9侧肢体,3区有4侧肢体,总体优良率为81.8%(18/22)。结论对于大龄儿童低磷酸血症佝偻病所致的下肢畸形,采用多段截骨、带锁髓内针坚强固定的方法,可取得良好的矫正效果。

Objective To retrospectively assess the outcomes and influencing factors of correcting deformity with multilevel osteotomy plus rigid intramedullary nail fixation in elder children with X-linked hypophosphatemic rickets (X-LHPR). Methods From August 2007 to December 2016, 17 X-LHPR children (5 boys and 12 girls) were admitted for deformity correction. The mean operative age was 153 (133-183) months. All of them had bilateral lower limb malalignments, including 28 limbs in varus and 8 limbs in valgus. Results Among 55 corrective procedures, 26 limbs (21 varus, 5 valgus) underwent intramedullary nail fixations, including 16 anteriograde femoral, 6 retrograde femoral and 17 tibial segments. The follow-ups were conducted for an average period of 40.5 (14-96) months after initial surgery. Osteotomic healing was obtained within a mean period of 6.3 (4-9) months and normal weight-bearing was restored. There was no occurrence of infections, neurovascular complications or nonunion. At the latest follow-up, mechanical axis was ultimately located in Zone 1 for 9 limbs. Another 9 limbs were in Zone 2 and 4 limbs in Zone 3. Overall fineness rate was 81.8%. Conclusions For elder X-LHPR children, excellent outcomes of deformity correction may be achieved by multilevel osteotomy plus intramedullary nail fixation.