Korompilias Anastasios V, Lykissas Marios G, Soucacos Panayiotis N, Kostas Ioannis, Beris Alexandros E
Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Ioannina, Greece.
Microsurgery. 2009;29(5):346-52. doi: 10.1002/micr.20649.
Congenital pseudarthrosis of the tibia (CPT) remains one of the most challenging problems confronting the orthopaedic surgeon. The operative results are frequently less than successful; many cases require several surgical procedures, and a significant number of them ending in amputation. The purpose of this study was to access the surgical results, complications, secondary procedures, and long-term results of free vascularized fibular graft (FVFG) in the treatment of congenital pseudarthrosis of the tibia. Between 1992 and 2007, nine patients with CPT were treated consecutively at our clinic with free fibula transfer. There were six females and three males. The mean age at the time of operation was 6.5 years (range, 1-12 years). Stability, after reconstruction with FVFG, was maintained with internal fixation in five patients, unilateral frame external fixation in three patients, and intramedullary pin in one patient. Average postoperative follow-up time was 9 years (range, 2-15 years). In seven patients, both ends of the graft healed primarily within 3.7 months (range, 1.5-6 months). In one patient, the distal end of the graft did not unit. This patient required three subsequent operations to achieve union. Stress fracture occurred in the middle of the grafted fibula in one patient, who underwent four additional operations before union, was achieved. Despite the relatively high-complication rate, FVFG remains a valid method for the treatment of CPT. However, even achieving union of pseudarthrosis is not enough for the resolution of the disease. This is only half of the problem; the other half is to maintain union. Long-term follow-up beyond skeletal maturity, if possible, is necessary to evaluate surgical results.
先天性胫骨假关节（CPT）仍然是骨科医生面临的最具挑战性的问题之一。手术结果往往不尽人意；许多病例需要多次手术，其中相当一部分最终以截肢告终。本研究的目的是评估游离血管化腓骨移植（FVFG）治疗先天性胫骨假关节的手术效果、并发症、二次手术及长期结果。1992年至2007年期间，我们诊所连续对9例CPT患者进行了游离腓骨移植治疗。其中女性6例，男性3例。手术时的平均年龄为6.5岁（范围1 - 12岁）。5例患者在FVFG重建后通过内固定维持稳定，3例患者采用单侧框架外固定，1例患者采用髓内针固定。术后平均随访时间为9年（范围2 - 15年）。7例患者移植骨的两端在3.7个月内（范围1.5 - 6个月）基本愈合。1例患者移植骨的远端未愈合。该患者需要后续进行3次手术才能实现愈合。1例患者移植的腓骨中部发生应力性骨折，在实现愈合之前又接受了4次手术。尽管并发症发生率相对较高，但FVFG仍然是治疗CPT的一种有效方法。然而，即使实现了假关节的愈合，对于疾病的解决来说也还不够。这只是问题的一半；另一半是维持愈合。如有可能，在骨骼成熟后进行长期随访对于评估手术效果是必要的。
