Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
BMC Musculoskelet Disord. 2021 May 28;22(1):490. doi: 10.1186/s12891-021-04382-7.
Difficulty in obtaining union, recurrent fractures, and residual deformities remain the problems challenging the management of congenital pseudarthrosis of the tibia (CPT). We applied the "Eiffel Tower" double titanium elastic nails (TENs) in the existing combined approach, which takes advantages of TEN's mechanical stability with the protection against refracture, Ilizarov's high fusion rate with alignment control and the biologic environment provided by bone grafting for bony union. The results of this procedure are presented and discussed.
Seventeen patients with CPT treated by combined surgery including pseudarthrosis resection, the "Eiffel Tower" double TENs technique, autogenous iliac bone grafting, and Ilizarov fixation between 2013 and 2019 were retrospectively investigated. Signs of bone union, limb length discrepancy (LLD), rate of refracture, and degree of residual deformities were reviewed. The AOFAS Ankle Hindfoot scale and measurement of ankle motion were used to evaluate ankle function. The mean follow-up time was 40.5 (11 to 91) months.
The mean age at index surgery was 6.2 (2.5 to 15) years. Union of the pseudarthrosis was achieved in 100% of cases. Among them, 15 (88.2%) patients obtained union of the pseudarthrosis on the first attempt (primary union). The average time to primary union was 3.8 (2 to 6) months. The rest 2 cases achieved union after additional surgeries (secondary union). In terms of complications, refracture occurred in 2 patients (11.8%) and 4 patients (23.5%) developed pin infection. The mean limb length discrepancy at the final follow up was 33.4 (6-141) mm. The average AOFAS score improved from 38.2 (27 to 51) pre-operatively to 77 (63 to 87) post-operatively (p < 0.01).
The "Eiffel Tower" double TENs technique is an ideal intramedullary fixation method in the surgical treatment of CPT. The combination of TENs technique with bone grafting and Ilizarov fixation has the advantages of early bone union, less injury on metaphysis, and early functional recovery.
Level IV.
先天性胫骨假关节（CPT）的治疗仍然存在骨不连、再骨折和残留畸形等问题。我们应用“埃菲尔铁塔”双钛弹性钉（TENs）于现有的联合治疗方法中，该方法结合了 TEN 的机械稳定性，防止再骨折，Ilizarov 技术高融合率和对线控制以及植骨提供的骨愈合的生物环境。现报道并讨论该手术的结果。
回顾性分析 2013 年至 2019 年采用联合手术治疗的 17 例 CPT 患者，手术包括假关节切除、“埃菲尔铁塔”双 TENs 技术、自体髂骨植骨和 Ilizarov 固定。观察骨愈合、肢体长度差异（LLD）、再骨折率和残留畸形程度。采用美国矫形足踝协会（AOFAS）踝后足评分和踝关节运动测量评估踝关节功能。平均随访时间为 40.5（11-91）个月。
初次手术时的平均年龄为 6.2（2.5-15）岁。100%的病例实现了假关节的愈合。其中，15 例（88.2%）患者首次尝试（一期愈合）即获得假关节愈合。一期愈合的平均时间为 3.8（2-6）个月。其余 2 例经额外手术（二期愈合）后获得愈合。并发症方面，2 例（11.8%）发生再骨折，4 例（23.5%）发生钉道感染。末次随访时的平均肢体长度差异为 33.4（6-141）mm。术前 AOFAS 评分为 38.2（27-51）分，术后为 77（63-87）分，差异有统计学意义（p<0.01）。
“埃菲尔铁塔”双 TENs 技术是治疗 CPT 的一种理想的髓内固定方法。TENs 技术联合植骨和 Ilizarov 固定具有早期骨愈合、对干骺端损伤小和早期功能恢复的优点。
IV 级。
