摘要
目的探讨胫骨截骨近端开槽逆行交锁髓内钉固定矫正儿童及青少年胫骨骨纤维结构不良(osteofibrous dysplasia,OFD)所致畸形的疗效。方法回顾性分析2016年1月至2019年12月接受胫骨截骨近端开槽逆行交锁髓内钉固定矫正胫骨骨纤维结构不良畸形患儿的病历资料,随访3年以上且资料齐全的患儿15例,男8例、女7例,年龄(10.1±2.5)岁(范围7.1~12.6岁)。均为单侧,左侧8例、右侧7例。比较术前、术后和末次随访时影像学改变,包括病变范围(病灶纵向长度/胫骨长度)、胫骨冠状位及矢状位力线、双下肢不等长。结果15例患儿均获得随访,随访时间为(3.4±1.3)年(范围3.0~6.6岁)。术前均存在明显胫骨前弓畸形及跛行,其中7例有疲劳性疼痛、3例存在病理性骨折。术后疼痛症状消失,跛行改善9例、消失6例。15例患儿胫骨截骨或骨折端的骨愈合时间为(3.9±0.7)个月(范围3~5个月)。术前病变范围为0.41±0.17,术后即刻为0.38±0.17,末次随访时为0.30±0.16,差异无统计学意义(F=0.101,P=0.904)。术前胫骨前弓角为28.30°±6.62°(范围20°~45°),术后即刻为4.73°±1.53°,末次随访时为6.87°±1.36°,差异有统计学意义(F=159.739,P<0.001)。术前胫骨在冠状面无明显成角畸形,胫骨近端内侧角及胫骨远端外侧角分别为87.50°±1.46°和88.30°±1.62°,术后即刻分别为88.40°±1.46°和88.70°±1.45°,末次随访时分别为88.00°±1.39°和89.10°±1.53°,差异均无统计学意义(F=1.741,P=0.188;F=1.016,P=0.371)。术前双下肢不等长为(0.60±0.98)cm,末次随访时为(0.18±0.93)cm,差异无统计学意义(t=0.096,P=0.761)。术后未出现感染等并发症。结论对胫骨骨纤维结构不良导致的胫骨畸形不行病灶刮除,仅行楔形截骨矫形恢复下肢力线,截骨近端开槽逆行交锁髓内钉固定可获得良好的矫形效果,且不损伤青少年儿童的胫骨近、远端骺板。
Objective To delineate the surgical methodology and therapeutic paradigm of proximal tibial notch retrograde interlocking intramedullary nailing for ameliorating deformities due to osteofibrous dysplasia(OFD)in a pediatric population.Methods A retrospective assessment was conducted on the medical records of individuals undergoing orthopedic osteotomy complemented by retrograde interlocking intramedullary nailing for OFD of the tibia from January 2016 to December 2019.The cohort comprised 15 patients,with a follow-up exceeding three years,documenting complete data sets.The patient profile included 8 males and 7 females,with 8 left-side and 7 right-side afflictions.The mean age at the time of surgery was 10.1±2.5 years,ranging from 7.1 to 12.6 years.Parameters measured were preoperative and postoperative imaging findings,which encompassed the scope of the lesion(longitudinal lesion length relative to tibial length),coronal and sagittal limb alignments,and lower limb length discrepancies.Results The mean follow-up duration was 3.4±1.3 years,ranging from 3 to 6.6 years.Preoperatively,prominent anterior tibial arch deformities and limping were present,with 7 cases reporting fatigue-induced pain and 3 instances of pathological fractures.Post-surgery,pain symptoms were resolved,gait disturbances were improved in 9 patients,and completely resolved in 6.Tibial osteotomy or fracture healing of 15 patients averaged 3.9±0.7 months(range 3-5 months).The lesion range before surgery was 0.41±0.17,immediately after surgery was 0.38±0.17,and at the last follow-up was 0.30±0.16,with no statistical significance(F=0.101,P=0.904).Lesion range showed no significant change throughout treatment,but radiographic density within the lesion notably increased post-surgery,suggesting bone improvement.The anterior tibial arch Angle was 28.30°±6.62°(range 20°-45°)before surgery,4.73°±1.53°immediately after surgery,and 6.87°±1.36°at the last follow-up,with statistical significance(F=159.739,P<0.001).A significant correction in the anterior tibial arch deformity was achieved and maintained postoperatively.There was no significant angular deformity of the tibia in the coronal plane before operation,and the medial proximal tibial angle(MPTA)and lateral distal tibial angle(LDTA)were 87.50°±1.46°and 88.30°±1.62°,88.40°±1.46°and 88.70°±1.45°immediately after surgery,and 88.00°±1.39°and 89.10°±1.53°at the last follow-up,the differences were statistically significant(F=1.741,P=0.188;F=1.016,P=0.371),there was no coronal deformity of tibia.The limb length discrepancy(LLD)was 0.60±0.98 cm before surgery,0.18±0.93 cm at the last follow-up,with statistical significance(t=0.096,P=0.761).There were no incidents of postoperative complications such as infection.Conclusion In pediatric cases of tibial deformities attributed to osteofibrous dysplasia,a therapeutic strategy involving osteotomy for lower limb realignment,sans curettage or bone grafting of the lesion,followed by retrograde interlocking intramedullary nailing,yields favorable outcomes.Importantly,this implantation technique does not compromise the integrity of the proximal tibial epiphyseal plate in children and adolescents.
作者
陈兆强
杨建平
张中礼
胡永成
付喆
王侃
邓书贞
Chen Zhaoqiang;Yang Jianping;Zhang Zhongi;Hu Yongcheng;Fu Zhe;Wang Kan;Deng Shuzhen(Department of Pediatric Orthopaedics,Tianjin Hospital,Tianjin 300211,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2024年第5期308-314,共7页
Chinese Journal of Orthopaedics
关键词
胫骨
纤维发育不良
单骨
肌肉骨骼畸形
截骨术
骨折固定术
髓内
Tibia
Fibrous dysplasia,monostotic
Musculoskeletal abnormalities
Osteotomy
Fracture fixation,intramedullary
