摘要
目的介绍经足踝髓内固定、包裹式自体髂骨移植和Ilizarov环形外固定器联合手术技术及其详细的手术操作方法，初步评价其治疗儿童先天性胫骨假关节的临床结果。方法自2007年3月开始至2010年7月，采取经足踝髓内棒固定、自体髂骨移植和Ilizarov环形外固定器联合手术方法，治疗51例儿童先天性胫骨假关节，手术时平均年龄为3．2岁（10个月至12．5岁），3岁以下者共31例（占61％）。按照Crowford分型，其中Ⅱ型5例、Ⅲ型3例、Ⅳ型43例。经历过一次手术者8例，二次手术者3例，三次手术者4例，四次手术者2例。按照Johnston临床分级系统、Ohnishi。X线分级标准进行结果评价。结果所有病例均获得完整随访，平均随访时间1．6年（6个月至3．1年），其中获得2年以上随访共19例。本组51例拆除Ilizarov外固定装置的平均时间为3．5个月（3-4．5个月）。按照Johnston临床分级系统，Ⅰ级26例，Ⅱ级21例，Ⅲ级4例；按照OhnishiX线分级标准，假关节愈合42例，假关节延迟愈合5例，假关节不愈合4例。随访发现，胫骨短缩畸形20例，胫骨过度生长3例，胫骨力线异常16例，踝外翻23例。结论经足踝髓内固定、自体髂骨移植和Ilizarov环形外固定器的联合技术，是治疗儿童胫骨假关节的相对可靠的方法。初期随访结果表明联合手术技术不仅明显的明显的缩短愈合时间，也降低了再骨折发生率，尤其适用于多次手术失败的病例。
Objective To describe the surgical technique of using intramedullary rods, Ilizarov ring external fixation device, and package-autogenously iliac bone graft for treatment congenital pseudarthrosis of tibia in children, and evaluate its clinical efficacy. Methods Since March 2007 to Ju- ly 2010, 5l cases with congenital pseudarthrosis of tibia underwent surgery in our center via combina- tion of intramedullary rods, Ilizarov ring external fixation device and package-autogenously iliac bone graft. The average age of patients was 3.2 years （ranging from 10 months to 12. 5 years）, in which 33 cases （61%） of them were less than 3 years. Referring to the Crowford classification criteria, type Ⅱwas in 5 cases, typeⅢ was in 3 cases and type IV was in 43 cases. Johnston clinical evaluation system and Ohnishi xray grading standards were employed for evaluation of results. Results Average fol- lowed-up time were 1.6 years （ranging from 7 months to 3. 1 years） in all patients, in which more than 2 year follow up was done in 39 cases. The average time of remove to Ilizarov external fixation device were 3.5 months （ranging from 3 to 4. 5 months）. Johnston clinical evaluation indicated that grade I were in 26 cases, grade Ⅱ was in 2l cases and grade Ⅲwas in 4 cases. Furthermore, Ohnishi x-ray evaluation showed that pseudarthrosis of tibial healed in 42 cases, delayed healing was in 5 cases, nowhealing in 4 cases. Conclusions The combination of intramedullary rod fixation, package- autogenous iliac bone graft and Ilizarov ring external fixation, is a reliable method for treatment of congenital pseudoarthrosis of tibia in children. Initial followed-up results indicate that it not only can significantly decrease healing time, but also reduce the incidence of re-fracture, especially suitable for the cases undergoing secondarv surgery.
出处
《中华小儿外科杂志》
CSCD
北大核心
2012年第6期421-425,共5页
Chinese Journal of Pediatric Surgery
关键词
胫骨
骨折固定术
髓内
骨移植
外固定器
Tibia
Fracture foxation, intramedullary
Bone transplantation
External fixators
