胫骨近端发育不良对CPT术后预后影响的相关性研究

发布时间：2018-01-26 11:56

  本文关键词： 先天性胫骨假关节 胫骨近端发育不良 愈合率 下肢力线 踝外翻畸形　出处：《南华大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:研究胫骨近端发育不良是否影响先天性胫骨假关节的假关节愈合,以及是否影响先天性胫骨假关节术后胫骨不等长、胫骨力线及踝外翻。方法:采集的符合纳入条件的CPT病例总数为66例,平均手术年龄为3.59±2.67岁,平均随访时间为3.55±1.29年。其中研究组32例,为伴有胫骨近端发育不良的CPT患者;对照组34例,为不伴有胫骨近端发育不良的CPT患者。研究组中16例有胫骨近端喇叭状改变,14例有胫骨近端骺板前倾,28例有胫骨前方皮质凹陷,有以上三种胫骨改变的有10例。根据改良Ohnishi X线评价两组患者胫骨假关节的愈合情况。按照Paley提出的测量方法测量两组患者术前与术后的胫骨不等长长度、术后胫骨力线角度。统计两组患者术后再骨折发生情况。两组得到的结果通过统计学对比分析。结果:(1)按照改良Ohnishi X线评价骨愈合情况:研究组32例患者中达到骨愈合的为24例,延迟愈合2例,不愈合6例,愈合率为75.0%,平均愈合时间为28.0±29.2周。对照组34例患者中达到骨愈合的为29例,延迟愈合2例,不愈合3例,愈合率为85.3%,平均愈合时间为24.8±23.0周;两组胫骨假关节愈合率与愈合时间无差异(P0.05)。(2)按照Paley提出的测量方法测量两组患者术前与术后胫骨不等长的长度:术前研究组患侧胫骨平均短缩3.48±4.24cm,对照组患侧胫骨平均短缩2.43±3.40cm;术后研究组患侧胫骨平均短缩2.49±3.38cm,对照组患侧胫骨平均短缩1.10±3.35cm。两组术前与术后胫骨不等长均无差异(P0.05)。(3)按照Paley提出的测量方法测量下肢力线:两组患者力线角度异常在股骨远端外侧解剖角(a LDFA)中研究组7例,对照组6例;胫骨近端内侧角(MPTA)中研究组18例,对照组14例;胫骨远端外侧角(LDTP)中研究组17例,对照组15例;两组胫骨成角畸形术前研究组平均为18.1±14.4°,对照组平均为22.3±12.7°,术后研究组平均为7.3±3.8°,对照组平均为5.6±6.5°。两组在MPTA角度及胫骨成角畸形有差异(P0.05);在a LDFA、LDTP及术前成角畸形无差异(P0.05)。(4)采用Malhotra踝外翻分级标准评估踝外翻:对照组:0级4例,I级10例,Ⅱ级10例,Ⅲ级10例;研究组:0级2例,I级3例,Ⅱ级11例,Ⅲ级16例。两组踝外翻分级有差异(P0.05)。(5)再骨折:研究组6例,对照组4例。两组再骨折发生率无差异(P0.05)。(6)腓骨假关节:对照组23例,研究组24例。两组腓骨假关节发生率无差异(P0.05)。结论:1、胫骨近端发育不良对联合手术治疗CPT患者的胫骨成角角度、胫骨力线之MPTA角度以及踝外翻畸形有显著影响;2、胫骨近端发育不良对联合手术治疗CPT患者的假关节的愈合时间、愈合率、腓骨假关节发生率、再骨折发生率、胫骨力线之a LDFA及LDTP角度无影响。
[Abstract]:Objective: to study whether proximal tibial dysplasia affects the healing of pseudoarthrosis and the unequal length of tibia after congenital pseudarthrosis of tibia. Methods: 66 cases of CPT were collected and the mean operative age was 3.59 卤2.67 years. The mean follow-up time was 3.55 卤1.29 years. 32 cases in study group were CPT patients with proximal tibia dysplasia. In the control group, 34 cases were CPT patients without proximal tibial dysplasia. In the study group, there were 14 cases with proximal tibial trumpet changes and 28 cases with anterior cortical depression of the tibial proximal epiphyseal plate. According to modified Ohnishi, there were 10 cases with the above three tibial changes. X ray was used to evaluate the healing of the pseudarthrosis of tibia in both groups. The length of tibia before and after operation was measured according to the measurement method proposed by Paley. Postoperative tibial force angle. Statistics of the occurrence of postoperative refracture in both groups. The results obtained in the two groups were compared and analyzed statistically. Results: 1). Bone healing was evaluated by modified Ohnishi X-ray: 24 of 32 patients in the study group achieved bone healing. There were 2 cases of delayed healing and 6 cases of non-union, the healing rate was 75.0 and the average healing time was 28.0 卤29.2 weeks. In the control group, 29 cases achieved bone healing and 2 cases delayed healing. The healing rate was 85.3 and the average healing time was 24.8 卤23.0 weeks. There was no difference in the healing rate and healing time of tibial pseudarthrosis between the two groups. According to the measurement method proposed by Paley, the length of tibia was measured before and after operation in two groups: the average shortening of tibia was 3.48 卤4.24 cm in the study group before and after operation. In the control group, the average shortening of the tibia was 2.43 卤3.40 cm. The average shortening of tibia was 2.49 卤3.38 cm in the study group. In the control group, the average tibia shortening was 1.10 卤3.35cm.There was no significant difference in tibia length between the two groups before and after operation. To measure the force line of lower extremity according to the measurement method proposed by Paley: there were 7 cases in study group in which the angle of force line was abnormal in the lateral anatomic angle of distal femur. Control group (6 cases); There were 18 cases in the study group and 14 cases in the control group. There were 17 cases in the study group and 15 cases in the control group. The mean value of tibial angulation malformation was 18.1 卤14.4 掳before operation, 22.3 卤12.7 掳in control group and 7.3 卤3.8 掳in postoperative study group. The average value of the control group was 5.6 卤6.5 掳. There were significant differences in MPTA angle and tibia angulation between the two groups (P 0.05). There was no difference in LDTP and preoperative angular malformation (P0.05U. 4) Malhotra criteria were used to evaluate the valgus of the ankle: 4 cases of grade 0 in the control group. There were 10 cases of grade I, 10 cases of grade 鈪，

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