包裹式自体髂骨移植治疗儿童先天性胫骨假关节的疗效观察

目的 介绍治疗儿童先天性胫骨假关节的特殊表面植骨方法--"包裹式自体髂骨移植"的手术技术,探讨其促进假关节愈合的作用机制.方法 2007年3月至2010年7月,湖南省儿童医院骨科在采用髓内棒固定、Ilizarov环形外固定装置固定和自体髂骨移植的联合手术方法中,采用包裹式自体髂骨移植治疗儿童先天性胫骨假关节51例,手术...

Effect of enclosing autogenous iliac bone graft in treatment for congenital pseudarthrosis of the tibial in children.

Objective To describe the surgical technique of a special surface bone grafting method enclosing autogenous iliac bone graft for treatment congenital pseudarthrosis of tibial in children and explore its role of the healing mechanism. Methods Since March 2007 to July 2010, 51 cases with congenital pseudarthrosis of the tibial were treated using combination of intramedullary rods, Ilizarov ring fixator , and enclosing autogenous iliac bone graft. The average age of operation was 3.2 years （ ranged from 10 monthes to 12.5 years） , of which 31 cases （61%） were younger 3 years. According to Crawford classification, type Ⅱ were 5 eases, type Ⅲ3 cases, type Ⅳ43 cases. Results All cases were evaluated by Johnston Clinical evaluation system and Ohnishi x-ray grading standards. 3 - 4 months after operations, all cases were found that the bone graft sites of pseudarthrosis of the tibial showed a significant augmentation and spindle-shaped expansion. All eases of this group have been followed-up, the average follow-up time was 1.6 years （7 months to 3. 1 years） , of which 19 cases were longer than 2 years followed-up. The average time of removed the Ilizarov ring fixator was 3.5 months （ 3 months to 4.5 months）. According to Johnston Clinical evaluation system, grade I were 26 cases, grade Ⅱ21 cases, grade Ⅲ4 cases; Following the Ohnishi x-ray evaluation standards, healing of pseudarthrosis of the tibial were 42 eases, delayed union 5 cases, non-union 4 cases. Conclusions Autogenous iliac bone graft can offer the activity of osteoblasts and osteogenesis induced by bone morphogenetie protein and glycoprotein , meanwhile enclosing bone graft helps keeping cancellous bone fragments in close contact around pseudarthrosis of the tibial, allowing the formation of high concentration of glycoprotein and bone morphogenetic protein induced by chemical factors which could enhance the healing of pseudarthrosis of the tibial.