Cai Wenquan, Su Yuxi, Nan Guoxin
Orthopaedics Department, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.
J Child Orthop. 2022 Jun;16(3):167-173. doi: 10.1177/18632521221097525. Epub 2022 Jun 30.
Congenital pseudarthrosis of the tibia is a rare disease that is particularly difficult to treat; the most difficult complications include nonunion of the tibia, refracture, and failed surgery. This study aimed to evaluate the efficiency of transposing gastrocnemius flaps for the treatment of congenital pseudarthrosis of the tibia.
Nine patients (aged 6.2 ± 3.6 years) diagnosed with congenital pseudarthrosis of the tibia in our hospital between March 2013 and March 2018 were enrolled. The tibial pseudarthrosis and thickened periosteum were completely removed, and intramedullary nails were used to fix the tibia. Bone harvest from the iliac, mixed with allogenic bone, was filled in the gap created by excision of the pseudarthrosis site and the surrounding periosteum; the gastrocnemius flap was then used to wrap the pseudoarthrosis site. The plaster cast was fixed postoperatively. The tibial union was evaluated via radiograph, and the plaster cast was removed after 12-24 weeks. Patients began walking approximately 12-14 weeks postoperatively.
Anatomical reduction was achieved in all the patients; the mean bone healing time was 10.1 ± 2.1 months. Bone nonunion was observed in one patient, and no neurovascular injury or wound infection occurred. Limb length discrepancy was in the range 3.2 ± 1.8 cm at 1 year and 4.7 ± 2.7 cm at 2 years after surgery. Two patients underwent replacement of the intramedullary nail, and eight patients exhibited good functional and radiographic outcomes.
This preliminary study proved that using the gastrocnemius muscle flap to cover the pseudarthrosis site was an effective method to promote the tibial union and treat congenital pseudarthrosis of the tibia.
先天性胫骨假关节是一种罕见且治疗难度极大的疾病；最棘手的并发症包括胫骨不愈合、再骨折以及手术失败。本研究旨在评估腓肠肌瓣移位术治疗先天性胫骨假关节的疗效。
选取2013年3月至2018年3月在我院确诊为先天性胫骨假关节的9例患者（年龄6.2±3.6岁）。彻底切除胫骨假关节及增厚的骨膜，采用髓内钉固定胫骨。取自髂骨的骨块与同种异体骨混合，填充于假关节部位及周围骨膜切除后形成的间隙；然后用腓肠肌瓣包裹假关节部位。术后用石膏固定。通过X线片评估胫骨愈合情况，术后12 - 24周拆除石膏。患者术后约12 - 14周开始行走。
所有患者均实现解剖复位；平均骨愈合时间为10.1±2.1个月。1例患者出现骨不愈合，未发生神经血管损伤或伤口感染。术后1年肢体长度差异为3.2±1.8 cm，术后2年为4.7±2.7 cm。2例患者更换了髓内钉，8例患者功能和影像学结果良好。
这项初步研究证明，使用腓肠肌肌瓣覆盖假关节部位是促进胫骨愈合及治疗先天性胫骨假关节的有效方法。
