联合手术治疗儿童先天性胫骨假关节的长期随访评价

Long term follow-up evaluation of combined surgery for congenital tibial pseudarthrosis in children

目的探讨联合手术治疗儿童先天性胫骨假关节的远期效果。方法回顾性收集湖南省儿童医院骨科2007年8月至2011年10月采用联合手术(胫骨假关节病变组织切除+经足踝髓内棒固定+Ilizarov外固定器固定+包裹式自体髂骨植骨)治疗的44例先天性胫骨假关节患儿的临床资料。男33例,女11例,手术时年龄(3.7±2.2)岁(范围:0.6~12.4岁),其中3岁以下25例,3岁以上19例。其中37例合并神经纤维瘤病1型。记录患儿手术情况、术后并发症情况及随访结果。结果术后随访时间为(10.9±0.7)年(范围:10~11年)。44例患儿中,39例(88.6%)实现胫骨假关节初期愈合,愈合时间(4.3±1.1)个月(范围:3~10个月)。末次随访时,胫骨不等长36例(81.8%),再骨折20例(45.4%),踝外翻18例(40.9%),胫骨近端外翻9例(20.4%),高弓足11例(25.0%)。9例(20.4%)发生胫骨远端骺板骨桥。17例(38.6%)存在胫骨机械轴线异常。7例(15.9%)发生针道感染,1例(2.3%)发生胫骨骨髓炎。21例(47.7%)患儿患侧股骨过度生长。5例(11.3%)患儿踝关节僵硬,34例(77.2%)患儿髓内棒发生移位,未在胫骨髓腔中央。其中8例(18.1%)突出胫骨骨皮质,行髓内棒取出。18例患儿已达到骨骼发育成熟,26例患儿未随访至骨骼发育成熟。结论联合手术治疗儿童先天性胫骨假关节的初期愈合率高,但长期随访中出现胫骨不等长、再骨折、踝外翻等并发症,需多次手术治疗。

Objective To explore the long-term effect of combined surgery for the treatment of congenital tibial pseudarthrosis in children.Methods The clinical data of 44 children with congenital tibial pseudarthrosis who underwent combined surgery(tibial pseudarthrosis tissue resection,intramedullary rod fixation,Ilizarov external fixator fixation,wrapped autologous iliac bone graft)from August 2007 to October 2011 at the Department of Pediatric Orthopedics,Hunan Children′s Hospital were collected retrospectively.There were 33 males and 11 females.The age at the time of surgery was(3.7±2.2)years(range:0.6 to 12.4 years),including 25 cases under 3 years old and 19 cases above 3 years old.Among them,37 cases were complicated with neurofibromatosis type 1.The operation status,postoperative complications and follow-up results were recorded.Results The follow-up time after surgery was(10.9±0.7)years(range:10 to 11 years).Thirty-nine out of 44 patients(88.6%)achieved initial healing of tibial pseudarthrosis,with an average healing time of(4.3±1.1)months(range:3 to 10months).In the last follow-up,36 cases(81.8%)had unequal tibial length,20 cases(45.4%)had refractures,18 cases(40.9%)had ankle valgus,9 cases(20.4%)had proximal tibial valgus,and 11 cases(25.0%)had high arched feet.Nine cases(20.4%)developed distal tibial epiphyseal plate bridging.17 cases(38.6%)had abnormal tibial mechanical axis.Seven cases(15.9%)developed needle infection,and one case(2.3%)developed tibial osteomyelitis.21 patients(47.7%)had excessive growth of the affected femur.Five patients(11.3%)had ankle stiffness,and 34 patients(77.2%)had intramedullary rod displacement that was not in the center of the tibial medullary cavity.Among them,8 cases(18.1%)protruded the tibial bone cortex and underwent intramedullary rod removal.18 children have reached skeletal maturity,while 26 children have not been followed up until skeletal maturity.Conclusion Combined surgery for the treatment of congenital pseudarthrosis of the tibia in children has a high initial healing rate,but complications such as unequal tibia length,refracture,and ankle valgus occur during long-term follow-up,requiring multiple surgical treatments.