【作者】 凌林；

【导师】 张湘生；

【作者基本信息】 中南大学 ， 外科学， 2008， 硕士

【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。更多还原

【Abstract】 ObjectiveTo 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.MethodA 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).ResultsAll 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.ConclusionVFG 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.更多还原