目的 探讨“三联方案”(阶段性功能锻炼、佩戴胫骨延长辅助支具、延长速度个体化)预防先天性胫骨假关节(CTP)胫骨延长治疗中膝关节屈曲挛缩的临床疗效。方法 回顾性分析2013年7月至2016年11月间本院收治的42例实施联合手术加胫骨延长治疗的CTP患儿临床资料并对随访结果进行分析。结果 42例均获得完整随访,平均随访8个月(4～17个月),外固定架平均佩戴时间228 d(118～456 d); 平均延长长度4.4 cm,早期愈合率100%,平均愈合指数52 d/cm; 拆除外固定支架时膝关节功能优40例,良2例; 无一例发生血管神经损伤、轴线移位、关节脱位、固定针折断、骨不愈合等。结论 “三联方案”预防CPT胫骨延长治疗后膝关节屈曲挛缩效果良好,值得临床推广。
Objective To explore the efficacy of "triple program" of staged functional exercise,wearing tibial extension auxiliary braces and individualized lengthening for preventing knee joint flexion contracture during tibial lengthening in children with congenital pseudarthrosis of the tibia(CTP). Methods A retrospective study was performed for 42 CPT patients undergoing surgery plus tibial lengthening from July 2013 to November 2016. Results The average follow-up period was 8(4-17)months.The average wearing time of external fixator was 228(118-456)days and the average length of lengthening 4.4 cm.All patients achieved primary union.The average healing index was 52 d/cm.After removing external fixator,the outcomes of knee function were excellent(n=40)and good(n=2).There was no instance of nerve injury,axial displacement,joint dislocation,broken needle or nonunion. Conclusion The “triple program” is effective in preventing flexion contracture of knee joint in CPT children during tibial lengthening.And wider clinical application is recommended.
