Liu Yaoxi,Wu Jiangyan,Yang Ge,et al.Clinical evaluation of proximal tibial extension in children with congenital pseudarthrosis of the tibia[J].Journal of Clinical Pediatric Surgery,,():147-151.[doi:10.3760/cma.j.cn101785-202204086-009]
Clinical evaluation of proximal tibial extension in children with congenital pseudarthrosis of the tibia
- Keywords:
- Congenital Pseudarthrosis of the Tibia; Tibia; Bone Lengthening; Bony Callus; Treatment Outcome
- Abstract:
- Objective To evaluate the healing index and complications of proximal tibial lengthening in children with congenital pseudarthrosis of the tibia (CPT).Methods From February 2012 to December 2019,retrospective analysis was conducted for clinical data of 57 CPT children undergoing proximal tibial extension using Ilizarov external fixation device.The average follow-up period was 72.9 months.According to the average value of healing index, group A had a healing index <57.1 cm/d and group B a healing index of >57.1 cm/d.At Month 1 post-operation,radiographic examination was performed for evaluating the quality of callus with Li classification.Postoperative complications of tibial lengthening were recorded.Results The average healing index was 57.1 d/cm.The average operative age was 80 months in group A with an average follow-up period of 75.5 months and an average extension length of 5.9 cm.And 81% of them obtained decent callus morphology and quality after 1-month extension with a healing index of 39.1 d/cm.The average operative age was 100.9 months in group B with an average follow-up time period of 69.6 months.The average extension length was 4.9 cm.And 56% of them obtained decent callus morphology after 1-month extension with a healing index of 80.1 d/cm.There were early fibular healing during tibial lengthening (n=3),needle infection (n=5),ankle joint stiffness (n=3),20 degree deformity of ankle metatarsal flexion (n=1),extended segment angulation deformity (n=4) and limited movement of knee joint (n=8).Conclusions The average healing index of CPT children is 57.1 d/cm during tibial lengthening.There are such complications as early fibular healing and angled extension segments.During lengthening,close attention should be paid to the morphology of callus.
References:
[1] 刘尧喜,陈琰,郑宇,等.儿童先天性胫骨假关节病变骨膜组织的蛋白质组学研究[J].中华骨科杂志,2021,41(2):92-102.DOI:10.3760/cma.j.cn121113-20200920-00570.Liu YX,Chen Y,Zheng Y,et al.Proteomics investigation on periosteum of children with tibia congenital pseudarthrosis[J].Chin J Orthop,2021,41(2):92-102.DOI:10.3760/cma.j.cn121113-20200920-00570.
[2] 朱光辉,梅海波,刘昆,等.OPG及RANKL在儿童先天性胫骨假关节病变骨与骨膜中的表达研究[J].临床小儿外科杂志,2019,18(4):331-334.DOI:10.3969/j.issn.1671-6353.2019.04.017.Zhu GH,Mei HB,Liu K,et al.Expressions of OPG and RANKL in tibia and periosteum of children with congenital tibial pseudarthrosis of the tibia[J].J Clin Ped Sur,2019,18(4):331-334.DOI:10.3969/j.issn.1671-6353.2019.04.017.
[3] 汤用波,梅海波.先天性胫骨假关节的病因学研究进展[J].临床小儿外科杂志,2013,12(3):234-236.DOI:10.3969/j.issn.1671-6353.2013.03.023.Tang YB,Mei HB.Research advances on etiology of congenital pseudarthrosis of tibia[J].J Clin Ped Sur,2013,12(3):234-236.DOI:10.3969/j.issn.1671-6353.2013.03.023.
[4] Liu YX,Mei HB,Zhu GH,et al.Congenital pseudarthrosis of the tibia in children:should we defer surgery until 3 years old?[J].J Pediatr Orthop B,2018,27(1):17-25.DOI:10.1097/BPB.0000000000000468.
[5] Rozbruch SR,Kleinman D,Fragomen AT,et al.Limb lengthening and then insertion of an intramedullary nail:a case-matched comparison[J].Clin Orthop Relat Res,2008,466(12):2923-2932.DOI:10.1007/s11999-008-0509-8.
[6] Ilizarov GA.The tension-stress effect on the genesis and growth of tissues:Part I.The influence of stability of fixation and soft-tissue preservation[J].Clin Orthop Relat Res,1989,238:249-281.
[7] Li R,Saleh M,Yang L,et al.Radiographic classification of osteogenesis during bone distraction[J].J Orthop Res,2006,24(3):339-347.DOI:10.1002/jor.20026.
[8] Cho TJ,Choi IH,Lee KS,et al.Proximal tibial lengthening by distraction osteogenesis in congenital pseudarthrosis of the tibia[J].J Pediatr Orthop,2007,27(8):915-920.DOI:10.1097/bpo.0b013e31815a6058.
[9] Jang WY,Choi YH,Park MS,et al.Physeal and subphyseal distraction osteogenesis in atrophic-type congenital pseudarthrosis of the tibia:efficacy and safety[J].J Pediatr Orthop,2019,39(8):422-428.DOI:10.1097/BPO.0000000000000979.
[10] Zhu GH,Mei HB,He RG,et al.Effect of distraction osteogenesis in patient with tibial shortening after initial union of congenital pseudarthrosis of the tibia (CPT):a preliminary study[J].BMC Musculoskelet Disord,2015,16:216.DOI:10.1186/s12891-015-0680-5.
[11] Balci HI,Bayram S,Pehlivanoglu T,et al.Effect of lengthening speed on the quality of callus and complications in patients with congenital pseudarthrosis of tibia[J].Int Orthop,2021,45(6):1517-1522.DOI:10.1007/s00264-021-05011-7.
[12] Donnan LT,Gomes B,Donnan A,et al.Ilizarov tibial lengthening in the skeletally immature patient[J].Bone Joint J,2016,98-B(9):1276-1282.DOI:10.1302/0301-620X.98B10.37523.
Memo
收稿日期:2022-4-28。
基金项目:湖南省卫生健康委一般指导课题(D202304078395);湖南省科卫联合基金(2022JJ70007;2021JJ70081);湖南省临床医疗技术创新引导项目(2021SK50526)
通讯作者:谭谦,Email:9154523@qq.com