Soldado Francisco, Barrera-Ochoa Sergi, Romero-Larrauri Pablo, Nguyen Trong-Quynh, Diaz-Gallardo Paula, Guerra Ernesto, Knörr Jorge
Pediatric Hand Surgery and MicrosurgeryBarcelona Children's Hospital, HM Nens, HM Hospitales, Barcelona, Spain.
Hand Surgery Unit, ICATME, Centre Medic Quiron Deixeus, Barcelona, Spain.
Microsurgery. 2022 May;42(4):326-332. doi: 10.1002/micr.30868. Epub 2022 Feb 8.
Congenital pseudarthrosis of the tibia (CPT) is one of the most challenging orthopedic disorders. The use of a vascularized tibial periosteal grafts has been recently reported as a powerful tool to obtain bone union. We report its use in CPT.
Retrospective short-term study of 29 children (18 male/11 female, 15 right-sided/14 left-sided) of mean age 45 months (range 11-144 months), operated upon after October 2014. Nonunion site was debrided, and the periosteum of the involved limb was excised. A vascularized tibial periosteal graft (mean length 10.7 cm (range 9-15 cm) with a monitoring skin island (mean length 4.1 cm (range 3-5 cm) and based on the anterior tibial vessels, was obtained from the contralateral tibia. Anterior tibial vessels were always the recipient vessels. Most cases were stabilized with an LCP plate. The rate of and time to bone union were analyzed. Charts only were evaluated through the first 3 months after bone union was achieved.
The flap survived and bone union was obtained in all cases, through a periosteal callus, in a mean time of 5.1 weeks (range 3-6 weeks). Mean follow-up was 8.3 months (range 7-19 months). No union failures occurred 3 months after resuming unprotected weight bearing.
Our novel technique produced a consistent, rapid capacity for CPT union, superior to previously-reported techniques. However, it cannot be recommended as a standard method of treatment until consistent, long-term, refracture-free follow-up is documented.
先天性胫骨假关节（CPT）是最具挑战性的骨科疾病之一。最近有报道称，使用带血管蒂的胫骨骨膜移植是实现骨愈合的有力手段。我们报告其在CPT中的应用。
对2014年10月之后接受手术的29例儿童（18例男性/11例女性，15例右侧/14例左侧）进行回顾性短期研究，平均年龄45个月（范围11 - 144个月）。对骨不连部位进行清创，并切除患侧肢体的骨膜。从对侧胫骨获取带血管蒂的胫骨骨膜移植片（平均长度10.7 cm（范围9 - 15 cm），带有监测皮岛（平均长度4.1 cm（范围3 - 5 cm）），以胫前血管为蒂。胫前血管始终作为受区血管。大多数病例用锁定加压钢板（LCP）固定。分析骨愈合率和愈合时间。仅在骨愈合后的前3个月通过图表进行评估。
所有病例中皮瓣均存活，通过骨膜骨痂实现骨愈合，平均时间为5.1周（范围3 - 6周）。平均随访8.3个月（范围7 - 19个月）。恢复无保护负重3个月后未发生骨不连失败情况。
我们的新技术使CPT实现了稳定、快速的愈合能力，优于先前报道的技术。然而，在有持续、长期、无再骨折的随访记录之前，不能推荐将其作为标准治疗方法。
