儿童先天性胫骨假关节术后并发症与手术时年龄的相关性研究

目的 探讨儿童先天性胫骨假关节(congenital pseudarthrosis of tibia,CPT)不同手术年龄与术后并发症间的关系.方法 回顾性分析2007年12月至2011年10月收治的59例Crawford Ⅳ型CPT患儿的临床资料.根据CPT手术时年龄大小,将其分为小于3岁组(A组,34例)和大于3岁组(B组,25例),比较2组患儿胫骨假关节初期愈合率、再骨折发生率,踝外翻、胫骨外翻和下肢不等长这些后遗畸形的发生情况.结果 A组31例(91.2％)患儿实现初期愈合.其中,7例(22.6％)发生再骨折;14例(45.2％)发生踝外翻,平均踝外翻11.3度(5～25度);13例(41.9％)发生胫骨外翻,胫骨平均外翻8.5度(5～20度);14例(45.2％)存在下肢不等长,平均下肢不等长2.4 cm(0.5～4.0 cm).B组21例(84.0％)患儿实现初期愈合.其中,7例(33.3％)发生再骨折;8例(38.1％)发生踝外翻,平均踝外翻13.8度(5～30度);12例(57.1％)发生胫骨外翻,胫骨平均外翻9.5度(5～20度);16例(76.2％)存在下肢不等长,平均下肢不等长1.8 cm(1～3 cm).B组下肢不等长发生率比A组高,差异有统计学意义(P=0.044).结论 1岁以上CPT患儿一旦形成胫骨假关节,如患儿无严重骨质疏松、营养状况较差等不利条件;即可考虑手术治疗,以减少术后下肢不等长并发症的发生.

Relationship between postoperative complications and operative age for congenital pseudarthrosis of the tibia in children

Objective To explore the relationship of postoperative complications and operative age for congenital pseudarthrosis of the tibia (CPT) in children.Methods A retrospective study was conducted on the relationship of postoperative complications and operative age for CPT in children.Between December 2007 to October 2011,59 patients with Crawford type Ⅳ CPT undergoing combined operative procedures were analyzed.They were divided into 2 groups,i.e.CPT aged ＜ 3 years (group A) and CPT aged ＞ 3 years (group B) according to operative age.We compared the incidence of re-fracture,ankle valgus,proximal tibial valgus and limb length discrepancy of two groups.Results In group A,31/34 (91.2％) patients achieved primary union,7 (22.6％) cases had refracture,14 (45.2％) cases of ankle valgus had an average ankle valgus of 11.3 (5-25),13 (41.9％) cases of proximal tibial valgus had an average proximal tibial valgus of 8.5 (5-20) and 14 (45.2％) cases had limb length discrepancy with an average limb length of 2.4 (0.5-4.0) cm.In group B,21/25 (84.0％) patients achieved primary union,7 (33.3％) cases had re-fracture,8 (38.1％) cases of ankle valgus had an average ankle valgus of 13.8 (5-30),12 (57.1％) cases of proximal tibial valgus had an average proximal tibial valgus of 9.5 (5-20) and 16 (76.2％) cases of limb length discrepancy had an average limb length of 1.8 (1-3) cm.Significant inter-group differences existed in limb length discrepancy (P =0.044).Conclusions For CPT patients aged above 1 year without no severe osteoporosis and decent nutritional status,surgery should be preformed to reduce the incidence of postoperative complications of limb length discrepancy.