镶嵌式骨外固定器治疗先天性胫骨假关节的临床研究
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摘要
目的
比较应用镶嵌式骨外固定器与带血管腓骨移植治疗先天性胫骨假关节(CPT)的临床疗效,为临床合理选择治疗方法提供依据。
方法
回顾性研究2000年至今应用镶嵌式骨外固定器加压治疗的11例CPT患者,男5例,女6例。平均年龄6.0岁(1.1～11.2岁);以Akio Sakamoto于2008年3月报道的行带血管腓骨移植治疗的8例CPT患者为对照组,其中男3例,女5例;平均年龄7.0岁(1.9～11.5岁)。对2组病例的如下数据之间进行对比分析评价:初次手术愈合率、再骨折率、总愈合率、愈合时间、肢体长度恢复率(肢体不等长＜2cm)、畸形发生率(向前成角及踝外翻＞20°)。
结果
全部病人均获随访。
1.镶嵌式骨外固定器加压治疗病例组:术后平均随诊6.4年(2.8～7.6年),初次术后假关节均获得愈合,初次愈合率100%,平均愈合时间5.9月(4～8月),再骨折1例。双下肢不等长＞2cm者7例。患肢遗留畸形(向前成角及踝外翻)＞20°者2例。
2.带血管腓骨移植治疗病例组:术后平均随诊11.7年(4.9～19.6年),初次术后有1例假关节未取得愈合,初次愈合率88%;该例患者经再次带血管腓骨移植治疗后假关节愈合,假关节平均愈合时间6.6月(4～10月),再骨折1例。双下肢不等长＞2cm者5例。患肢遗留畸形(向前成角及踝外翻)＞20°者4例。
结论
带血管腓骨移植是现在公认治疗CPT的有效方法。通过应用镶嵌式骨外固定器加压与带血管腓骨移植治疗CPT临床疗效的对比研究,我们认为应用镶嵌式骨外固定器加压亦为治疗CPT理想方法之一。
Objective
To compare the clinical effects of the use of monolateral external fixator and vascularized fibular graft(VFG)for treatment of the congenital pseudarthrosis of the tibia(CPT),provide evidence for clinical reasonable select therapy.
Method
A retrospective study was carried out in 19 patients who are treated with the monolateral external fixator or VFG for congenital pseudarthrosis of the tibia.5 boys and 6 girls were treated with the monolateral external fixator,average age at 6.0years(range:1.1～11.2years).3 boys and 5 girls were treated by vascularized fibular grafting,average age at 7.0 years(range:1.9-11.5 years).
Results
All patients were followed-up.
1.Monolateral external fixator group:Followed-up for average 6.4years(range:2.8～7.6years),Bone consolidation was obtained in all cases after an average term of 5.9months(range:4～8months),The initial bone consolidation rate was 100%.Refracture occurred in 1.Leg-length discrepancy＞2cm occurred in 7.There were 2 of the patients show residual deformity with the tibial valgus and/or anterior bowing＞20°.
2.VFG group:Followed-up for average 11.7 years(range:4.9～ 19.6years),Bone consolidation was obtained in all cases after an average term of 6.6 months(range:4-10 months);this was with the first VFG in 7 cases but with the second VFG in 1 case.The initial bone consolidation rate was 88%.Refracture occurred in 1.Leg-length discrepancy＞2cm occurred in 5.Residual deformity with the tibial valgus and/or anterior bowing＞20°occurred in 4.
Conclusion
VFG is generally acknowledged as an ideal method for CPT nowadays.According to the result of this study,use the Monolateral external fixator for the treatment of CPT is an acceptable method as well.
比较应用镶嵌式骨外固定器与带血管腓骨移植治疗先天性胫骨假关节(CPT)的临床疗效,为临床合理选择治疗方法提供依据。
方法
回顾性研究2000年至今应用镶嵌式骨外固定器加压治疗的11例CPT患者,男5例,女6例。平均年龄6.0岁(1.1～11.2岁);以Akio Sakamoto于2008年3月报道的行带血管腓骨移植治疗的8例CPT患者为对照组,其中男3例,女5例;平均年龄7.0岁(1.9～11.5岁)。对2组病例的如下数据之间进行对比分析评价:初次手术愈合率、再骨折率、总愈合率、愈合时间、肢体长度恢复率(肢体不等长＜2cm)、畸形发生率(向前成角及踝外翻＞20°)。
结果
全部病人均获随访。
1.镶嵌式骨外固定器加压治疗病例组:术后平均随诊6.4年(2.8～7.6年),初次术后假关节均获得愈合,初次愈合率100%,平均愈合时间5.9月(4～8月),再骨折1例。双下肢不等长＞2cm者7例。患肢遗留畸形(向前成角及踝外翻)＞20°者2例。
2.带血管腓骨移植治疗病例组:术后平均随诊11.7年(4.9～19.6年),初次术后有1例假关节未取得愈合,初次愈合率88%;该例患者经再次带血管腓骨移植治疗后假关节愈合,假关节平均愈合时间6.6月(4～10月),再骨折1例。双下肢不等长＞2cm者5例。患肢遗留畸形(向前成角及踝外翻)＞20°者4例。
结论
带血管腓骨移植是现在公认治疗CPT的有效方法。通过应用镶嵌式骨外固定器加压与带血管腓骨移植治疗CPT临床疗效的对比研究,我们认为应用镶嵌式骨外固定器加压亦为治疗CPT理想方法之一。
Objective
To compare the clinical effects of the use of monolateral external fixator and vascularized fibular graft(VFG)for treatment of the congenital pseudarthrosis of the tibia(CPT),provide evidence for clinical reasonable select therapy.
Method
A retrospective study was carried out in 19 patients who are treated with the monolateral external fixator or VFG for congenital pseudarthrosis of the tibia.5 boys and 6 girls were treated with the monolateral external fixator,average age at 6.0years(range:1.1～11.2years).3 boys and 5 girls were treated by vascularized fibular grafting,average age at 7.0 years(range:1.9-11.5 years).
Results
All patients were followed-up.
1.Monolateral external fixator group:Followed-up for average 6.4years(range:2.8～7.6years),Bone consolidation was obtained in all cases after an average term of 5.9months(range:4～8months),The initial bone consolidation rate was 100%.Refracture occurred in 1.Leg-length discrepancy＞2cm occurred in 7.There were 2 of the patients show residual deformity with the tibial valgus and/or anterior bowing＞20°.
2.VFG group:Followed-up for average 11.7 years(range:4.9～ 19.6years),Bone consolidation was obtained in all cases after an average term of 6.6 months(range:4-10 months);this was with the first VFG in 7 cases but with the second VFG in 1 case.The initial bone consolidation rate was 88%.Refracture occurred in 1.Leg-length discrepancy＞2cm occurred in 5.Residual deformity with the tibial valgus and/or anterior bowing＞20°occurred in 4.
Conclusion
VFG is generally acknowledged as an ideal method for CPT nowadays.According to the result of this study,use the Monolateral external fixator for the treatment of CPT is an acceptable method as well.
引文
[1]葛宝丰,卢世壁,主编.手术学全集,矫形外科卷.人民军医出版社,1996:1198-1199.
[2]Grill F,Bollini G,Dungl P,et al.Treatment approaches for congenital pseudarthrosis of tibia:Results of the EPOS multicenter study.European Paediatric Orthopaedic Society.J Pediatr Orthop B,2000,2:75-89.
[3]lizarov GA,Gracheva VI.Bloodless treatment of congenital pseudarthrosis of the crus with simultaneous elimination of shortening using dosed distraction.Orthop Traumatol Protez,1971,32:42-46.
[4]Paley D,Catagni M,Argnani F,et al.Treatment of congenital pseudoarthrosis of the tibia using the Ilizarov technique.Clin Orthop,1992,280:81-93.
[5]Akio Sakamoto,Tatsuya Yoshida,Yoshio Uchida,et al.Long-term follow-up on the use of vascularized fibular graft for the treatment of congenital pseudarthrosis of the tibia.Journal of Orthopaedic Surgery and Research,2008,3:13
[6]雷伟,黄耀添,王剑波,等.先天性胫骨假关节的病因病理学研究.中华骨科杂志,1998,18(11):649-653.
[7]Smo T,Gerard B,Pavel D,et al.Functional results at the end of skeletal growth in 30patients affected by congenital pseudoarthrosis of the tibia.J Pediatr Orthop(Part B),2000,2:94-102.
[8]Ganger R,Petje G,schmid R.Congential pseudoarthrosis of the tibia in European Orthopade.2000,29:900
[9]Fritz H,Gérard B,Pavel D,et al.Congenital pseudarthrosis of the tibia:History,etiology,classification,and epidemiologic data.J Pediatr Orthop (Part,B),2000,1:11-15.
[10]Boyd HB.Pathology and nature history of congential pseudarthrosis of the tibia.Clin Orthop,1982,166:5-13.
[11]FranzG,GerardB,PavelD,et al.Treatment approaches for congenital pseudarthrosis of tibia:results of the EPOS multicenterstudy.J Pediatr Orthop(PartB),2000,2:75-89
[12] Benjamin Joseph, V. V. J. Somaraju, Sanath Kumar Shetty. Management of Congenital Pseudarthrosis of the Tibia in Children Under 3 Years of Age.J Pediatr Orthop.2003;23(6):740-746
[13] Bassett CAL ,Caulo N ,Kort J . Congenitial pseudarthrosis of the tibia : treatment with pulsing electromagnetic field. Clin Orthop,1981,154:136.
[14] Uchida Y, Kojima T, Sugioka Y: Vascularised fibular graft for congenital pseudarthrosis of the tibia. Long-term results. J Bone Joint Surg Br 1991, 73(5):846-850.
[15] Gilbert A, Brockman R: Congenital pseudarthrosis of the tibia.Long-term followup of 29 cases treated by microvascular bone transfer. Clin Orthop Relat Res 1995:37-44.
[16] Kanaya F, Tsai TM, Harkess J. Vascularized bone grafts for congenital pseudarthrosis of the tibia. Microsurgery 1996,17(8):459-69; discussion 470-1.
[17] Guidera KJ, Raney EM, Ganey T, et al. Ilizarov treatment of congenital pseudarthroses of the tibia. J Pediatr Orthop 1997,17(5):668-674.
[18] Isao Ohnishi,Wakyo Sato,Juntarou Matsuyama, et al.Treatment of Congenital Pseudarthrosis of the Tibia : A Multicenter Study in Japan. J Pediatr Orthop.2005;25(2):219-224
[19] Chen CW,Yu ZJ ,Wan Y. A new method oftreatment of congenital tibia pseudoarthrosis using free vascularized fibular grafts. AnnAcad Med Singapore ,1979,8 :465-473.
[20] Leung PC: Congenital pseudarthrosis of the tibia. Three cases treated by free vascularized iliac crest graft. Clin Orthop Relat Res. 1983:45-50.
[21] Leif Pal Kristiansen,Harald Steen,Terje Terjesen.Residual Challenges After Healing of Congenital Pseudarthrosis in the Tibia. Clin Orthop.2003,414:228-237.
[22] Tae-Joon Cho,In Ho Choi,Ki Seok Lee,et al. Proximal Tibial Lengthening by Distraction Osteogenesis in Congenital Pseudarthrosis of the Tibia. J Pediatr Orthop. 2007; 27(8):915-920
[23] Benjamin J ,George M. Management of congenital pseudarthrosis of the tibia by excision of the pseudarthrosis , onlay grafting ,and intramedullary nailing. J Pediatr Orthop(Part B),2000,1:16-23.
[24]M.B.Dobbs,Margaret Rich,J.Gordon,et al.Use of an Intramedullary Rod for Treatment of Congenital Pseudarthrosis of the Tibia.A Long-Term Follow-up Study.J Bone Joint Surg Am.2004;86:1186-1197.
[25]Inan M,El Rassi G,Riddle EC,et al.Residual deformities following successful initial bone union in congenital pseudoarthrosis of the tibia.J Pediatr Orthop 2006,26(3):393-399.
[26]Anderson DJ,Schoenecker PL,Sheridan JJ,et al.Use of an intramedullary rod for the treatment of congenital pseudarthrosis of the tibia.J Bone Joint Surg Am 1992,74(2):161-168.
[27]Morrissy RT,Riseborough EJ,Hall JE:Congenital pseudarthrosis of the tibia.J Bone Joint Surg Br 1981,63-B(3):367-375.
[28]Cosimo T,Gerard B,Pavel D,et al.Functional results at the end of skeletal growth in 30 patients affected by congenital pseudoarthrosis of the tibia.J Pediatr Orthop(Part B).2000,2:94-102.
[29]Wallace BL,Dan A,David SF,et al.Congenital pseudoarthrosis of the tibia.J Pediatr Orthop(Part B).2000,2:103-107.
[30]汤雪明.实验性骨折愈合的超微结构研究--成纤维细胞与软骨细胞演变和归宿的电子显微镜观察[J].中华医学杂志,1980,60(3):385
[1]葛宝丰,卢世壁,主编.手术学全集,矫形外科卷.人民军医出版社,1996:1198-1199.
[2]Boyd HB.Pathology and nature history of congential pseudarthrosis of the tibia.Clin Orthop,1982,166:5-13.
[3]雷伟,黄耀添,王剑波,等.先天性胫骨假关节的病因病理学研究.中华骨科杂志,1998,18(11):649-653.
[4]Fritz H,Gérard B,Pavel D,et al.Congenital pseudarthrosis of the tibia:History,etiology,classification,and epidemiologic data.J Pediatr Orthop (Part,B),2000,1:11-15.
[5]雷伟,黄耀添,王剑波等.先天性胫骨假关节病变组织增生活性的研究.中华小儿外科杂志,2000;21(5):302。
[6]雷伟,黄耀添,王剑波等.先天性胫骨假关节雌激素受体的免疫组织化学研究.中华小儿外科杂志,1999;20(4):234.
[7]Li Shuqiang,Wang Ping,Yu Yaqin,et al.Expressions of VEGF and TGF-β in periosteum in patients with congenital pseudarthrosis of tibia.Journal of Jilin University(Medicine Edition),2007,33(2):327-328.
[8]崔赓,雷伟,马平,等.BMP、IL-1、IL-6、TNF-a在先天性胫骨假关节中的的表达.中华骨科杂志,2001,21(2):111-114.
[9]崔赓,雷伟,李洁等.先天性胫骨假关节患者染色体核型的初步分析.中国临床康复,2003,7(17):2474-2475.
[10]FranzG,GerardB,PavelD,etal.Treatment approaches for congenital pseudarthrosis of tibia:results of the EPOS multicenterstudy.J Pediatr Orthop(PartB),2000,2:75-89
[11]Bassett CAL,Caulo N,Kort J.Congenitial pseudarthrosis of thetibia:treatment with pulsing electromagnetic field.Clin Orthop,1981,154:136.
[12]Chen CW,Yu ZJ,Wan Y.A new method iftreatment of congenital tibia pseudoarthrosis using free vascularized fibular grafts.AnnAcad Med Singapore,1979,8:465-473.
[13]Bertil R,Gerard B,Pavel D,et al.Free vascular fibular transfer in congenital pseudarthrosis of the tibia:results of the EPOS multicenter study.J Pediatr Orthop (PartB),2000,2:90
[14]lizarov GA,Gracheva VI.Bloodless treatment of congenital pseudarthrosis of the crus with simultaneous elimination of shortening using closed distraction.Orthop Traumatol Protez,1971,32:42-46.
[15]Grill F,Bollini G,Dungl P,et al.Treatment approaches for congenital pseudart hrosis of tibia:Results of the EPOS multicenter study.European Paediatric Ort hopaedic Society.J Pediatr Orthop B,2000,9:75-89.
[16]Paley D,Catagni M,Argnani F,et al.Treatment of congenital pseudoart hrosis of the tibia using the Ilizarov technique.Clin Orthop,1992,280:81-93.
[17]李起鸿,周仲安,马树枝,等.骨外固定技术治疗先天性胫骨假关节.中华骨科杂志,1996,16(10):623.
[18]王晓东,王科文,张锡庆.llizarov技术结合髓内克氏针治疗先天性胫骨假关节.中国矫形外科杂志,2002,10(14):1367-1368.
[19]Leif Pal K,Harald Steen,Terje Terjesen.Residual Challenges After Healing of Congenital Pseudarthrosis in the Tibia.Clin Orthop.2003,414:228-237.
[20]Smo T,Gerard B,Pavel D,et al.Functional results at the end of skeletal growth in 30patients affected by congenital pseudoarthrosis of the tibia.J Pediatr Orthop(Part B),2000,2:94-102.
[21]Wallace BL,Dan A,David SF,et al.Congenital pseudoarthrosis of the tibia.J Pediatr Orthop(Part B),2000,2:103-107.
[22]Michael Weber.Neurovascular Calcaneo-Cutaneus Pedicle Graft for Stump Capping in Congenital Pseudarthrosis of the Tibia:Preliminary Report of a New Technique.J Pediatr Orthop Part B.2002;11(1):47-52.
[2]Grill F,Bollini G,Dungl P,et al.Treatment approaches for congenital pseudarthrosis of tibia:Results of the EPOS multicenter study.European Paediatric Orthopaedic Society.J Pediatr Orthop B,2000,2:75-89.
[3]lizarov GA,Gracheva VI.Bloodless treatment of congenital pseudarthrosis of the crus with simultaneous elimination of shortening using dosed distraction.Orthop Traumatol Protez,1971,32:42-46.
[4]Paley D,Catagni M,Argnani F,et al.Treatment of congenital pseudoarthrosis of the tibia using the Ilizarov technique.Clin Orthop,1992,280:81-93.
[5]Akio Sakamoto,Tatsuya Yoshida,Yoshio Uchida,et al.Long-term follow-up on the use of vascularized fibular graft for the treatment of congenital pseudarthrosis of the tibia.Journal of Orthopaedic Surgery and Research,2008,3:13
[6]雷伟,黄耀添,王剑波,等.先天性胫骨假关节的病因病理学研究.中华骨科杂志,1998,18(11):649-653.
[7]Smo T,Gerard B,Pavel D,et al.Functional results at the end of skeletal growth in 30patients affected by congenital pseudoarthrosis of the tibia.J Pediatr Orthop(Part B),2000,2:94-102.
[8]Ganger R,Petje G,schmid R.Congential pseudoarthrosis of the tibia in European Orthopade.2000,29:900
[9]Fritz H,Gérard B,Pavel D,et al.Congenital pseudarthrosis of the tibia:History,etiology,classification,and epidemiologic data.J Pediatr Orthop (Part,B),2000,1:11-15.
[10]Boyd HB.Pathology and nature history of congential pseudarthrosis of the tibia.Clin Orthop,1982,166:5-13.
[11]FranzG,GerardB,PavelD,et al.Treatment approaches for congenital pseudarthrosis of tibia:results of the EPOS multicenterstudy.J Pediatr Orthop(PartB),2000,2:75-89
[12] Benjamin Joseph, V. V. J. Somaraju, Sanath Kumar Shetty. Management of Congenital Pseudarthrosis of the Tibia in Children Under 3 Years of Age.J Pediatr Orthop.2003;23(6):740-746
[13] Bassett CAL ,Caulo N ,Kort J . Congenitial pseudarthrosis of the tibia : treatment with pulsing electromagnetic field. Clin Orthop,1981,154:136.
[14] Uchida Y, Kojima T, Sugioka Y: Vascularised fibular graft for congenital pseudarthrosis of the tibia. Long-term results. J Bone Joint Surg Br 1991, 73(5):846-850.
[15] Gilbert A, Brockman R: Congenital pseudarthrosis of the tibia.Long-term followup of 29 cases treated by microvascular bone transfer. Clin Orthop Relat Res 1995:37-44.
[16] Kanaya F, Tsai TM, Harkess J. Vascularized bone grafts for congenital pseudarthrosis of the tibia. Microsurgery 1996,17(8):459-69; discussion 470-1.
[17] Guidera KJ, Raney EM, Ganey T, et al. Ilizarov treatment of congenital pseudarthroses of the tibia. J Pediatr Orthop 1997,17(5):668-674.
[18] Isao Ohnishi,Wakyo Sato,Juntarou Matsuyama, et al.Treatment of Congenital Pseudarthrosis of the Tibia : A Multicenter Study in Japan. J Pediatr Orthop.2005;25(2):219-224
[19] Chen CW,Yu ZJ ,Wan Y. A new method oftreatment of congenital tibia pseudoarthrosis using free vascularized fibular grafts. AnnAcad Med Singapore ,1979,8 :465-473.
[20] Leung PC: Congenital pseudarthrosis of the tibia. Three cases treated by free vascularized iliac crest graft. Clin Orthop Relat Res. 1983:45-50.
[21] Leif Pal Kristiansen,Harald Steen,Terje Terjesen.Residual Challenges After Healing of Congenital Pseudarthrosis in the Tibia. Clin Orthop.2003,414:228-237.
[22] Tae-Joon Cho,In Ho Choi,Ki Seok Lee,et al. Proximal Tibial Lengthening by Distraction Osteogenesis in Congenital Pseudarthrosis of the Tibia. J Pediatr Orthop. 2007; 27(8):915-920
[23] Benjamin J ,George M. Management of congenital pseudarthrosis of the tibia by excision of the pseudarthrosis , onlay grafting ,and intramedullary nailing. J Pediatr Orthop(Part B),2000,1:16-23.
[24]M.B.Dobbs,Margaret Rich,J.Gordon,et al.Use of an Intramedullary Rod for Treatment of Congenital Pseudarthrosis of the Tibia.A Long-Term Follow-up Study.J Bone Joint Surg Am.2004;86:1186-1197.
[25]Inan M,El Rassi G,Riddle EC,et al.Residual deformities following successful initial bone union in congenital pseudoarthrosis of the tibia.J Pediatr Orthop 2006,26(3):393-399.
[26]Anderson DJ,Schoenecker PL,Sheridan JJ,et al.Use of an intramedullary rod for the treatment of congenital pseudarthrosis of the tibia.J Bone Joint Surg Am 1992,74(2):161-168.
[27]Morrissy RT,Riseborough EJ,Hall JE:Congenital pseudarthrosis of the tibia.J Bone Joint Surg Br 1981,63-B(3):367-375.
[28]Cosimo T,Gerard B,Pavel D,et al.Functional results at the end of skeletal growth in 30 patients affected by congenital pseudoarthrosis of the tibia.J Pediatr Orthop(Part B).2000,2:94-102.
[29]Wallace BL,Dan A,David SF,et al.Congenital pseudoarthrosis of the tibia.J Pediatr Orthop(Part B).2000,2:103-107.
[30]汤雪明.实验性骨折愈合的超微结构研究--成纤维细胞与软骨细胞演变和归宿的电子显微镜观察[J].中华医学杂志,1980,60(3):385
[1]葛宝丰,卢世壁,主编.手术学全集,矫形外科卷.人民军医出版社,1996:1198-1199.
[2]Boyd HB.Pathology and nature history of congential pseudarthrosis of the tibia.Clin Orthop,1982,166:5-13.
[3]雷伟,黄耀添,王剑波,等.先天性胫骨假关节的病因病理学研究.中华骨科杂志,1998,18(11):649-653.
[4]Fritz H,Gérard B,Pavel D,et al.Congenital pseudarthrosis of the tibia:History,etiology,classification,and epidemiologic data.J Pediatr Orthop (Part,B),2000,1:11-15.
[5]雷伟,黄耀添,王剑波等.先天性胫骨假关节病变组织增生活性的研究.中华小儿外科杂志,2000;21(5):302。
[6]雷伟,黄耀添,王剑波等.先天性胫骨假关节雌激素受体的免疫组织化学研究.中华小儿外科杂志,1999;20(4):234.
[7]Li Shuqiang,Wang Ping,Yu Yaqin,et al.Expressions of VEGF and TGF-β in periosteum in patients with congenital pseudarthrosis of tibia.Journal of Jilin University(Medicine Edition),2007,33(2):327-328.
[8]崔赓,雷伟,马平,等.BMP、IL-1、IL-6、TNF-a在先天性胫骨假关节中的的表达.中华骨科杂志,2001,21(2):111-114.
[9]崔赓,雷伟,李洁等.先天性胫骨假关节患者染色体核型的初步分析.中国临床康复,2003,7(17):2474-2475.
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