摘要
目的初步探讨半骨骺阻滞术矫正先天性胫骨假关节(congenital pseudarthrosis of the tibia,CPT)术后胫骨近端外翻的内固定取出时机。方法回顾性分析湖南省儿童医院骨科2012年1月至2022年11月采用8字钢板半骨骺阻滞术治疗CPT术后出现胫骨近端外翻患儿临床资料。根据患儿取8字钢板时胫骨近端内侧角(anterior mechanical proximal tibial angle,aMPTA)矫正值进行分组(A组为≥87°,11例;B组为82°~87°之间,21例;C组为≤82°,7例)。收集患儿一般资料,手术前、取内固定时及末次随访时胫腓骨正侧位X线片,内固定时间,取出内固定后随访时间等资料;统计分析手术前、取内固定时及末次随访时的aMPTA、股骨远端外侧角(anterior lateral distal femoral angle,aLDFA)、胫骨近端后侧角(posterior proximal tibial angle,PPTA)及股骨远端后侧角(posterior distal femoral angle,PDFA),并统计复发情况,探索合适矫正角度范围。结果共39例纳入研究,其中男22例、女17例,左侧22例、右侧17例。三组手术时年龄、性别、侧别、总随访时间、内固定取出后随访时间差异无统计学意义(P>0.05)。A组手术前aMPTA为(99.63±6.44)°,取内固定时aMPTA为(89.53±2.60)°,末次随访时aMPTA为(90.63±1.93)°,反弹度数为(2.57±1.71)°,平均矫正速率(0.96±0.53)°/月;B组手术前aMPTA为(97.81±5.09)°,取内固定时aMPTA为(84.62±0.99)°,末次随访时aMPTA为(87.11±1.89)°,反弹度数为(2.84±1.00)°,平均矫正速率(1.19±0.74)°/月;C组手术前aMPTA为(93.57±5.55)°,取内固定时aMPTA为(78.71±1.98)°,末次随访时aMPTA为(87.20±3.12)°,反弹度数为(8.49±3.64)°,平均矫正速率(1.38±0.87)°/月。随访过程中2例螺钉松动,无一例内固定断裂、内固定失效、感染、骺板损伤等并发症发生。组间对比显示,三组取内固定时和末次随访的aMPTA差异均有统计学意义(P<0.01)。其中末次随访时A组和B组、A组和C组的aMPTA差异有统计学意义(P<0.01);B和C组的aMPTA差异无统计学意义(P>0.05)。手术前、取内固定时、末次随访时的aLDFA、PPTA、PDFA和矫正速率的差异均无统计学意义(P>0.05)。A组和C组、B组和C组的反弹度数差异有统计学意义(P<0.01),A组和B组的反弹度数差异无统计学意义(P>0.05)。结论半骨骺阻滞术治疗儿童先天性胫骨假关节愈合后胫骨近端外翻畸形时,建议取内固定时aMPTA设定在82°~87°。
Objective To preliminarily explore the timing of removing internal fixation for correcting congenital pseudarthosis of the tibia(CPT)after hemiepiphyseal blocking.Methods A retrospective analysis was conducted for the relevant clinical data of 39 children with proximal tibial eversion after CPT undergoing 8-shaped steel plate semi epiphyseal blocking at Department of Orthopedics,Hunan Children's Hospital from January 2012 to November 2022.According to the correction value of anterior mechanical proximal tibial angle(aMPTA)during plating,they were assigned into three groups of A(n=11,≥87°),B(n=21,82-87°)and C(≤82°,n=7).General profiles,radiographic images of the tibia and fibula were acquired at preoperation,during internal fixation removal and at the last follow-up,internal fixation time and follow-up time after removal of internal fixation.The parameters of aMPTA,anterior lateral femoral angle(aLDFA),posterior proximal tibial angle(PPTA)and posterior distal femoral angle(PDFA)at preoperation,during internal fixation removal and at the last follow-up were statistically analyzed for exploring an optimal range of correction angles.Results There were 22 boys and 17 girls.The involved side was left(n=22)and right(n=17).No statistically significant differences existed in age,gender,total follow-up time or follow-up time after removal of internal fixation among three groups during surgery(P>0.05).In group A,aMPTA was(99.63±6.44)°before surgery and(89.53±2.60)°during internal fixation.At the last follow-up,aMPTA was(90.63±1.93)°with a rebound degree of(2.57±1.71)°and an average monthly correction rate of(0.96±0.53)°;Before surgery,aMPTA of group B was(97.81±5.09)°and(84.62±0.99)°during internal fixation.At the last follow-up,aMPTA was(87.11±1.89)°with a rebound degree of(2.84±1.00)°and an average monthly correction rate of(1.19±0.74)°;Before surgery,MPTA of group C was(93.57±5.55)°and(78.71±1.98)°during internal fixation.At the last follow-up,aMPTA was(87.20±3.12)°with a rebound degree of(8.49±3.64)°and an average monthly correction rate of(1.38±0.87)°.During follow-ups,there were 2 cases of screw loosening without such complications as internal fixation fracture,internal fixation failure,infection or epiphyseal plate injury.Inter-group comparison revealed statistically significant differences in aMPTA among three groups during internal fixation and at the last follow-up(P<0.01).At the last follow-up,statistically significant difference existed in aMPTA between groups A and B,as well as between groups A and C(P<0.01);No statistically significant difference existed in aMPTA between groups B and C(P>0.05).Statistically significant differences existed in aLDFA,PPTA,PDFA and correction rate before surgery,during internal fixation and at the last follow-up(P>0.05).The difference in rebound degree was statistically significant(P<0.01).The differences of rebound degree were statistically significant between groups A/C and B/C(P<0.01)while no statistically significant difference existed in rebound degree between groups A and B(P>0.05).Group C had the highest rebound degree.Conclusions When using semi epiphyseal blocking for treating congenital tibial pseudarthrosis in children,aMPTA is ideally set between 82-87°during internal fixation.
作者
蔡豪杰
朱光辉
Cai Haojie;Zhu Guanghui(School of Pediatrics,University of South China,Hengyang 421001,China;Department of Orthopedics,Affiliated Children's Hospital of Xiangya School of Medicine,Central South University(Hunan Children's Hospital),Hunan Provincial Key Laboratory of Pediatric Orthopedics,Changsha 410007,China;Department of Pediatric Surgery,Loudi Central Hospital,Loudi 417000,China)
出处
《临床小儿外科杂志》
北大核心
2025年第11期1032-1036,共5页
Journal of Clinical Pediatric Surgery
基金
儿童骨科学湖南省重点实验室专项经费(2023TP1019)
国家重点研发计划-骨科难治性疾病诊疗新模式建立、评价及推广应用(2023YFC2507605)
湖南省儿童肢体畸形临床医学研究中心(2019SK4006)。
关键词
半月板
胫骨
生长面
骨骺阻滞
外科手术
儿童
Menisci,Tibial
Growth Plate
Epiphysiodesis
Surgical Procedures
Child
