Agarwal Anil
Specialist, Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, 110031, Delhi, India.
J Clin Orthop Trauma. 2019 Sep-Oct;10(5):999-1003. doi: 10.1016/j.jcot.2019.03.017. Epub 2019 Mar 24.
We retrospectively observed the fibular regeneration in non vascularized harvest in children and development of ankle valgus at 2 time points to find any possible relationship between them.
A 6 month period was chosen as the first time frame to assess regeneration and ankle valgus. Radiographs at this time and a subsequent follow up were studied for regeneration, lateral distal tibial ankle (LDTA) and fibular station. The donor sites were divided into complete and incomplete regeneration groups and compared statistically.
There were 12 patients with 18 harvested fibulae. Ten out of 18 fibulae (56%) had complete longitudinal regenerate at 6 months. Two fibulae underwent delayed union. Of 8 incomplete regenerates at 6 months, 6 (75%) were also incomplete beyond a follow up of 2.75 years. Incomplete group had radiological ankle valgus in 6 legs (75%) at 6 months increased to 7 at follow up. Further, LDTA for incomplete group was significantly lower than complete group (p = 0.025) at 6 months.
More than half of harvested legs (56%) had complete longitudinal fibular regeneration at 6 months. Of incomplete regenerates at 6 months, three fourth remained so beyond 2.5 years. Ankle valgus was found strongly related to long standing fibular non regeneration. Radiological ankle valgus developed early in the incomplete regenerate group.
我们回顾性观察了儿童非血管化取骨时腓骨的再生情况以及两个时间点的外翻足发育情况，以探寻它们之间可能存在的关系。
选取6个月的时间段作为评估再生情况和外翻足的首个时间框架。研究此时及后续随访时的X线片，观察再生情况、胫距关节外侧（LDTA）及腓骨位置。将供区分为完全再生组和不完全再生组，并进行统计学比较。
共有12例患者，取了18根腓骨。18根腓骨中有10根（56%）在6个月时实现了完全纵向再生。2根腓骨出现延迟愈合。6个月时8根不完全再生的腓骨中，随访2.75年后仍有6根（75%）不完全再生。不完全再生组6个月时6条腿（75%）出现影像学外翻足，随访时增至7条腿。此外，不完全再生组6个月时的LDTA显著低于完全再生组（p = 0.025）。
超过半数（56%）的取骨腿在6个月时实现了腓骨完全纵向再生。6个月时不完全再生的腓骨中，四分之三在2.5年以上仍保持不完全再生状态。发现外翻足与长期腓骨不再生密切相关。不完全再生组早期出现影像学外翻足。
