新型"U"形钉半骺板阻滞治疗先天性胫骨假关节术后踝外翻畸形的临床研究

Treatment of postoperative ankle valgus of congenital pseudarthrosis of the tibia by hemiepiphyseal fixing with a novel "U" -shaped screw

目的探讨新型"U"形钉治疗先天性胫骨假关节术后踝外翻的临床疗效和安全性。方法2013年5月至2020年6月湖南省儿童医院共收治了41例先天性胫骨假关节术后踝外翻采用"U"形钉治疗的患儿,其中男17例,女24例。通过在胫骨远端内侧植入新型"U"形钉来逐渐矫正踝外翻畸形。收集患儿手术时间、术中出血量、住院时间等资料。评价指标选用胫距角,通过术前、术后及末次随访影像资料,评价畸形矫正率和并发症情况。结果所有患儿术后随访至少16个月,平均随访36个月。平均手术时间24 min,术中出血量平均7.5 ml,平均住院时间4.4 d。所有患儿术前胫距角为(73.9±4.4)°,去除内固定时胫距角为(86.9±4.7)°,末次随访时胫距角为(84.6±5.5)°。所有患儿去除内固定时平均矫形率为0.69°/月。患儿术后均未出现螺钉脱出、骨髓炎、伤口感染等严重并发症,术后踝关节活动良好,无关节僵硬。患儿内固定拆除后未出现骺板损伤等情况。结论新型"U"形钉是一种治疗儿童先天性胫骨假关节术后踝外翻畸形安全有效的内固定系统。

Objective To explore the clinical efficacy and safety of a novel"U"-shaped screw for treating ankle valgus after operation for congenital pseudarthrosis of the tibia(CPT).Methods From May 2013 to June 2020,a total of 41 patients with ankle valgus after operation for CPT undergoing"U"-shaped tension screwing.There were 17 boys and 24 girls.A novel type of"U"-shaped screw was implanted into medial side of distal tibia for a gradual correction.Operative duration,intraoperative volume of blood loss and hospitalization stay were recorded.The evaluation index was tibiotalar angle.Deformity correction rates and complications were examined by preoperative,postoperative and follow-up imaging data.Results The follow-up period was at least 14 months with an average of 35 months.Average operative duration was 24 min,average volume of blood loss 7.5 ml and average hospitalization stay 4.4 day.Tibiotalar angle was(73.9±4.4°),(86.9±4.7°)and(84.6±5.5°)respectively at pre-operation,a removal of internal fixation and the last follow-up.Average monthly correction rate was 0.68°at a removal of internal fixation.No severe complications of screw prolapse,osteomyelitis or wound infection occurred and ankle movement was decent without joint stiffness.There was no epiphyseal plate injury after a removal of internal fixation.Conclusions The novel internal fixation system of"U"-shaped screw is both safe and effective for postoperative ankle valgus of CPT in children.