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目的总结手术治疗小儿先天性胫骨假关节的方法及疗效。方法 1993年1月-2003年12月,收治12例先天性胫骨假关节患儿。男9例,女3例;年龄2～10岁,平均5岁。左侧7例,右侧5例。除既往于外院采用游离贴附植骨术治疗失败2例分型不明外,其余10例根据Boyd分型:Ⅱ型7例,Ⅲ型2例,Ⅳ型1例。术中采用病灶清除、同侧带肌蒂腓骨贴附结合肋骨或对侧腓骨植骨、螺钉内固定辅以管型石膏外固定治疗。结果术后切口均Ⅰ期愈合。1例术后4周发生石膏浅表压疮,更换下肢支具并换药后愈合。患儿均获随访,随访时间5.5～7.0年,平均6.3年。X线片示术后平均6.7个月假关节均愈合。术后2个月1例出现向前成角畸形,经手术纠正后愈合。末次随访时,患肢较健侧平均短缩1.8cm,较术前平均短缩2.6cm明显改善。患肢膝、踝关节活动良好。结论病灶清除、同侧带肌蒂腓骨贴附结合肋骨或对侧腓骨植骨、螺钉内固定辅以管型石膏外固定治疗小儿先天性胫骨假关节手术操作简便,可避免较大创伤,且术后并发症少。
Objective To summarize the surgical treatment of pediatric congenital tibial pseudarthrosis and its efficacy. Methods From January 1993 to December 2003, 12 children with congenital tibial pseudarthrosis were treated. 9 males and 3 females; aged 2 to 10 years old, average 5 years old. 7 cases on the left and 5 cases on the right. In addition to the past two years in the outer hospital with free attachment of bone graft failed to identify two cases of unknown type, the remaining 10 cases according to Boyd classification: Ⅱ type 7 cases, Ⅲ type 2 cases, Ⅳ type 1 case. Intraoperative use of lesions removed, ipsilateral with muscle fibula attached to the ribs or the contralateral fibula graft, screw fixation with tube plaster external fixation. Results The incisions healed in the first stage. One case of gypsum superficial pressure sore occurred 4 weeks after the operation, replacing the lower limbs brace and healing. All patients were followed up for 5.5-7.0 years, an average of 6.3 years. X-ray showed an average of 6.7 months after surgery pseudarthrosis. One case had an anterior deformity at 2 months after operation and healed after surgery. At the last follow-up, the affected limbs contracted by an average of 1.8 cm compared with the contralateral side, which was significantly improved compared with the 2.6 cm shortened mean preoperatively. Limb knee, ankle well. Conclusions The removal of the lesion, ipsilateral pedicle fibular attachment with the rib or contralateral fibula graft, screw fixation with tube plaster external fixation for pediatric congenital tibial pseudarthrosis operation is simple and can avoid greater trauma, and surgery After complications less.