骨外固定技术治疗先天性胫骨假关节

先天性胫骨假关节（ＣＰＴ）仍是一个了解最少与治疗最困难的问题。传统方法治疗的成功率仅约５０％。作者报告用半环槽式外固定器治疗１１例ＣＰＴ。病人年龄２～１７岁，平均９岁。下肢短缩４～９ｃｍ。９例接受过１７次手术，包括３次带血管腓骨移植。手术治疗包括切除假关节端加压外固定同时行近干骺端截骨延长。结果９例假关节５～８个月愈合，１例２次手术１４个月愈合，１例未愈合。１１例骨延长５～９．５ｃｍ，平均７ｃｍ，愈合指数３３ｄ／ｃｍ。１０例随诊１～９年，平均３年１０个月。９例骨愈合与肢体功能良好，１例术后３年１１个月因明显外伤再骨折。作者认为骨外固定治疗ＣＰＴ创伤小，方法简便，同时可充分矫正患肢短缩畸形。半环槽式外固定器用克氏针做三维式外固定，固定稳固与负重活动产生的动力性轴向应力刺激是促进ＣＰＴ愈合的关键因素。

TreatmentofCongenitalPseudoarthrosisoftheTibiawithExternalFixation

Congenitalpseudoarthrosisofthetibia(CPT)remainsoneoftheproblemsleastunder-stoodandmostdificulttobesolved.Thesuccessfulrateoftheconventionaltreatmentwasonlyabout50%.Elevenpatients,agedfrom2to17years(withanaverageof9years),withCPTweretreatedwithexternalfixationusingthehalfringsulcatedfixationapparatus.Thelimbswereshortenedfrom4to9cm,withanaverageof6cm.Ninecaseshad17surgeries,including3vascularizedfibulagrafts,re-sectionofthepseudoarthrosisandexternalcompressivefixationcombinedwithlengtheningofthebonebymetaphyseotomies.Postoperatively,theCPThealedupwithin5to8monthsin9cases.Onehealedin14monthsaftersecondaryoperation,andonewentonnon-union.Thetibiawaslengthenedby5to9.5cm,withanaverageof7cminalofthe11cases.Thehealingindexwas33days/1cm.Exceptforonecase,10werefolowedupfor1to9years(mean3yearsand10months)andhadperfectfunctions.Theremainingonehadafractureduetotrauma47monthsafterthesurgery.Itisconsideredthatexter-nalcompressivefixationissuperiortovascularizedfibulagraftingforthetreatmentofCPTduetoitssimplemanagementanditsabilitytolengthenthelimb.Thestimulationofthedynamicaxialstressre-sultedfromstablefixationandweight-bearingisanimportantfactortopromotethebonehealingandre-construction.