A good index surgery for congenital pseudarthrosis of the tibia minimizes complications following surgery.

IF 2.8 Q1 ORTHOPEDICS
Si H S Tan, Yingzhi Pei, Chloe X Chan, Khang C Pang, Andrew K S Lim, James H Hui, Bo Ning
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引用次数: 0

Abstract

Aims: Congenital pseudarthrosis of the tibia (CPT) has traditionally been a difficult condition to treat, with high complication rates, including nonunion, refractures, malalignment, and leg length discrepancy. Surgical approaches to treatment of CPT include intramedullary rodding, external fixation, combined intramedullary rodding and external fixation, vascularized fibular graft, and most recently cross-union. The current study aims to compare the outcomes and complication rates of cross-union versus other surgical approaches as an index surgery for the management of CPT. Our hypothesis was that a good index surgery for CPT achieves union and minimizes complications such as refractures and limb length discrepancy.

Methods: A multicentre study was conducted involving two institutions in Singapore and China. All patients with CPT who were surgically managed between January 2009 and December 2021 were included. The patients were divided based on their index surgery. Group 1 included patients who underwent excision of hamartoma, cross-union of the tibia and fibula, autogenic iliac bone grafting, and internal fixation for their index surgery. Group 2 included patients who underwent all other surgical procedures for their index surgery, including excision of hamartoma, intramedullary rodding, and/or external fixation, without cross-union of the tibia and fibula. Comparisons of the rates of union, refracture, limb length discrepancy, reoperations, and other complications were performed between the two groups.

Results: A total of 36 patients were included in the study. Group 1 comprised 13 patients, while Group 2 comprised 23 patients. The mean age at index surgery was four years (1 to 13). The mean duration of follow-up was 4.85 years (1.75 to 14). All patients in Group 1 achieved bony union at a mean of three months (1.5 to 4), but ten of 23 patients in Group 2 had nonunion of the pseudarthrosis (p = 0.006). None of the patients in Group 1 had a refracture, while seven of 13 patients who achieved bony union in Group 2 suffered a refracture (p = 0.005). None of the patients in Group 1 had a limb length discrepancy of more than 2 cm, while ten of 23 patients in Group 2 have a limb length discrepancy of more than 2 cm (p = 0.006). In Group 1, four of 13 patients had a complication, while 16 of 23 patients in Group 2 had a complication (p = 0.004). Excluding removal of implants, four of 13 patients in Group 1 had to undergo additional surgery, while 18 of 23 patients in Group 2 had to undergo additional surgery following the index surgery (p = 0.011).

Conclusion: A good index surgery of excision of hamartoma, cross-union of the tibia and fibula, autogenic iliac bone grafting, and internal fixation for CPT achieves union and minimizes complications such as refractures, limb length discrepancy, and need for additional surgeries.

对先天性胫骨假关节进行良好的指数手术可最大限度地减少术后并发症。
目的:先天性胫骨假关节(CPT)历来是一种难以治疗的疾病,并发症发生率很高,包括不愈合、再骨折、错位和腿长不一致。治疗 CPT 的手术方法包括髓内植骨、外固定、髓内植骨和外固定联合术、血管化腓骨移植术以及最近的交叉愈合术。本研究旨在比较作为治疗 CPT 的指标手术的交叉接合与其他手术方法的疗效和并发症发生率。我们的假设是,一个好的 CPT 指征手术既能实现骨结合,又能将骨折和肢体长度不一致等并发症降至最低:我们在新加坡和中国的两家医院开展了一项多中心研究。所有在 2009 年 1 月至 2021 年 12 月期间接受过手术治疗的 CPT 患者均被纳入研究范围。根据患者的手术指数将其分为两组。第一组包括接受火腿肠瘤切除术、胫骨和腓骨交叉连接术、自体髂骨移植术和内固定术的患者。第 2 组包括在指标手术中接受所有其他手术治疗的患者,包括切除火腿肠瘤、髓内棒植入和/或外固定,但不包括胫骨和腓骨交叉粘连。对两组患者的骨结合率、骨折复发率、肢体长度不一致率、再次手术率和其他并发症发生率进行了比较:研究共纳入了 36 名患者。结果:共有 36 名患者参与了研究,其中第一组有 13 名患者,第二组有 23 名患者。手术时的平均年龄为 4 岁(1 至 13 岁)。平均随访时间为 4.85 年(1.75 至 14 年)。第一组的所有患者在平均三个月(1.5 到 4 个月)时都实现了骨性结合,但第二组的 23 位患者中有 10 位出现假关节不愈合(P = 0.006)。第一组中没有一名患者发生再骨折,而第二组中实现骨性结合的 13 名患者中有 7 名发生了再骨折(P = 0.005)。第一组中没有一名患者的肢体长度差异超过 2 厘米,而第二组的 23 名患者中有 10 名患者的肢体长度差异超过 2 厘米(P = 0.006)。第一组的 13 位患者中有 4 位出现并发症,而第二组的 23 位患者中有 16 位出现并发症(p = 0.004)。除去植入物的移除,第一组的13名患者中有4名需要接受额外手术,而第二组的23名患者中有18名需要在指标手术后接受额外手术(p = 0.011):结论:切除火腿肠瘤、胫骨和腓骨交叉愈合、自体髂骨移植、CPT内固定等良好的指标性手术可实现愈合,并最大限度地减少骨折、肢体长度不一致等并发症以及额外手术的需求。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Bone & Joint Open
Bone & Joint Open ORTHOPEDICS-
CiteScore
5.10
自引率
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审稿时长
8 weeks
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