儿童胫骨短缩延长矿化期钢板辅助内固定的临床效果

Clinical effect of plating after lengthening to assist the consolidation of tibial shortening in children

目的探讨儿童胫骨短缩畸形延长矿化期更换钢板辅助内固定的临床疗效。方法回顾性分析2019年11月至2022年10月天津市天津医院小儿骨科利用环形外固定架延长后更换钢板辅助内固定治疗的胫骨短缩10例患儿资料(钢板辅助组),并以同期单纯采用环形外固定架延长的患儿16例作为对照(外固定架组)。26例中男15例、女11例,左侧10例、右侧16例,手术时年龄为(8.8±4.7)岁(范围5.1~13.8岁)。对比两组患儿的性别、侧别、手术时年龄,记录两组患儿延长长度、外固定架指数、愈合指数、Kolcaba舒适状况量表评分、膝和踝关节活动度、并发症及平均住院总费用。结果钢板辅助组与外固定架组性别、侧别、手术时年龄的差异无统计学意义,延长长度分别为(5.44±1.25)、(5.78±1.11)cm,差异无统计学意义(t=0.096,P=0.096)。钢板辅助组外固定架指数及愈合指数为(17.86±2.94)、(40.94±6.63)d/cm,均短于外固定架组的(50.97±7.03)、(45.24±5.98)d/cm,差异有统计学意义(t=13.299,P<0.001;t=1.289,P=0.033)。矿化期更换钢板辅助内固定后患儿Kolcaba舒适状况量表评分(103.35±4.60)分明显高于外固定架组的(70.65±15.06)分,差异有统计学意义(t=6.821,P=0.001)。术前、延长结束及末次随访时两组膝和踝关节活动度比较的差异均无统计学意义。延长端愈合时钢板辅助组膝关节活动度(137.89°±4.40°)及踝关节活动度(64.35°±5.50°)均大于外固定架组(114.09°±13.60°和56.65°±8.86°),差异均有统计学意义(t=17.235,P<0.001;t=7.821,P=0.002)。钢板辅助组4例出现针道感染,无再骨折发生;外固定架组13例出现针道感染,2例拆除外固定架后发生再骨折。钢板辅助组平均住院总费用相对较高,差异有统计学意义(t=3.745,P=0.036)。结论儿童胫骨短缩延长矿化期更换钢板辅助内固定临床效果可靠,可显著缩短外固定架佩戴时间,利于截骨延长端愈合及膝、踝关节功能恢复,患儿舒适度高,并发症少,适用于大距离延长、多次延长、关节功能受限、外固定架耐受性差及治疗依从性差的患儿。

ObjectiveTo explore the clinical effect of plating after lengthening to assist the consolidation of tibial shortening deformity in children.MethodsA retrospective analysis was conducted on 10 children with tibial shortening who were treated with circular external fixator lengthening and replacement with plate-assisted internal fixation(study group)in the Department of Pediatric Orthopedics of Tianjin Hospital from November 2019 to October 2022,and 16 children who were treated by circular external fixator only during the same period were enrolled as the external fixator group(control group).Among the 26 cases,there were 15 males and 11 females,10 left knees and 16 right knees.The average age at the time of surgery was 8.8±4.7 years(range 5.1-13.8 years).The gender,side,age at the time of surgery were compared between the two groups.The extension length,external fixator index,healing index,Kolcaba comfort scale score,knee and ankle joint range of motion,complications and average total hospitalization costs were recorded.ResultsThere were no significant differences in gender,side,age at the time of surgery between the study group and control group.The extended lengths were 5.44±1.25 cm and 5.78±1.11 cm respectively without significant difference(t=0.096,P=0.096).The external fixator index and healing index were 17.86±2.94 d/cm vs.50.97±7.03 d/cm and 40.94±6.63 d/cm vs.45.24±5.98 d/cm in study group and the control group with significant differences(t=13.299,P<0.001;t=1.289,P=0.033).The Kolcaba comfort scale score of the children in the study group was higher than that of the control group,with significant difference(t=6.821,P=0.001).Comparing the range of motion of the knee and ankle joints between the two groups,there were no significant differences before surgery,at the end of extension surgery,and at the final follow-up.When the extension end was healed,the range of motion of the knee joint was137.89°±4.40°vs.114.09°±13.60°and ankle joint was 64.35°±5.50°vs.56.65°±8.86°in the study group and control group with significant difference(t=17.235,P<0.001;t=7.821,P=0.002).In the study group,4 cases had pin tract infection,but no refracture occurred;in the control group,pin tract infection occurred in 13 cases,and refracture occurred in 2 cases after removal of the external fixator.The average total hospitalization cost of the study group was higher than that of the control group with significant difference(t=3.745,P=0.036).ConclusionThe clinical effect of replacing plate-assisted internal fixator during the mineralization period of tibial shortening in children is reliable,and can significantly shorten the time for using external fixator.It is beneficial to the healing of the extended end of the osteotomy and the functional recovery of the knee and ankle joints.Being more comfortable for children with fewer complications,it is applicable for children who need long-distance extension,multiple extensions with limited joint function,poor tolerance for external fixators and low treatment compliance.