半骺板阻滞术治疗儿童先天性胫骨假关节手术后踝外翻的临床研究

Clinical study on the hemiepiphyseal treatment for postoperative ankle valgus in children with congenital pseudarthrosis of the tibia

目的回顾性分析经骺板内踝螺钉技术和“U”形钉技术两种半骺板阻滞术治疗儿童先天性胫骨假关节手术后踝外翻的临床疗效及安全性。方法2011年5月至2019年10月湖南省儿童医院骨科共收治44例先天性胫骨假关节手术后踝外翻患者,采用经骺板内踝螺钉技术治疗18例,为经骺板内踝螺钉组;“U”形钉技术治疗26例,为“U”形钉组。评价指标选用胫骨远端外侧角。记录患者一般资料,术前、术后及末次随访影像资料,比较两组畸形矫正情况和并发症发生率。结果术后随访至少13个月,平均35个月。经骺板内踝螺钉组术前胫骨远端外侧角平均(74.4±6.3)°,去除内固定时胫骨远端外侧角平均(87.6±3.4)°;“U”形钉组术前胫骨远端外侧角(73.9±5.1)°,去除内固定时胫骨远端外侧角(88.4±3.5)°。“U”形钉组矫形效果优于经骺板内踝螺钉组,但差异不显著(“U”形钉组矫形速率为每月0.69°,经骺板内踝螺钉组为每月0.63°,P>0.05)。经骺板内踝螺钉组术后发生内固定并发症2例,为螺钉陷入骨质导致取出困难。“U”形钉组无一例并发症发生。两组均无一例内固定失败或伤口感染发生。结论经骺板内踝螺钉和“U”形钉通过半骨骺阻滞均能有效纠正先天性胫骨假关节手术后踝外翻畸形,但是“U”形钉具有相对更好的矫形效果和更少的并发症。

Objective A retrospective analysis of the clinical efficacy and safety of hemiepiphyseal with transphyseal malleolar screw and U-shaped screw in the treatment of ankle valgus after operation of congenital pseudarthrosis of the tibia(CPT).Methods A total of 44 patients with postoperative ankle valgus after CPT operation from May 2011 to Oct 2019 were included.18 patients were treated with transphyseal malleolar screw and 26 patients were treated with“U”-shaped screw,and the evaluation index was the lateral distal tibia angle.The general data,and preoperative,postoperative and final follow-up radiological data were recorded,and the deformity correction rate and complications were compared.Results All the patients were followed up for at least 13 months(35 months on average)after operation.In the transphyseal malleolar screw group,the preoperative lateral distal tibia angle was(74.4±6.3)°,and the lateral distal tibia angle was(87.6±3.4)°when the internal fixation was removed;in the U-shaped screw group,the preoperative lateral distal tibia angle was(73.9±5.1)°,and the lateral distal tibia angle was(88.4±3.5)°when the internal fixation was removed.The effect of deformity correction in the U-shaped screw group was better than that in transphyseal malleolar screw group,but the difference was not significant(P>0.05).Complications of internal fixation occurred in 2 cases in the transphyseal malleolar screw group,presenting as difficulty in removing the screws due to sinking into the bone.No internal fixation failure or wound infection occurred in all patients.Conclusion Transphyseal malleolar screw and“U”-shaped screw both can effectively correct the postoperative ankle valgus CPT operation through hemiepiphyseal,but the U-shaped screw method has relatively better corrective effects and lower incidence of complications.