术前合并腓骨假关节与胫骨先天性假关节术后踝关节外翻风险的相关性。

Association between preoperative concurrent fibular pseudarthrosis and risk of postoperative ankle valgus in patients with congenital pseudarthrosis of the tibia.

机构信息

Department of Orthopedic Surgery, Hunan Children's Hospital, Changsha, Hunan, China.

Department of Orthopedic Surgery, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.

出版信息

BMJ Paediatr Open. 2023 Feb;7(1). doi: 10.1136/bmjpo-2022-001763.

DOI:10.1136/bmjpo-2022-001763

PMID:36863762

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9972442/

Abstract

BACKGROUND

This study evaluated the correlation of preoperative concurrent fibular pseudarthrosis with the risk of ankle valgus deformity in patients with congenital pseudarthrosis of the tibia (CPT) who underwent successful surgical treatment.

METHOD

The children with CPT who were treated at our institution between 1 January 2013 and 31 December 2020 were retrospectively reviewed. The independent variable was preoperative concurrent fibular pseudarthrosis, and the dependent variable was postoperative ankle valgus. Multivariable logistic regression analysis was performed after adjusting for variables that might affect the risk of ankle valgus. Subgroup analyses with stratified multivariable logistic regression models were used to assess this association.

RESULTS

Of the 319 children who underwent successful surgical treatment, 140 (43.89%) developed ankle valgus deformity. Moreover, 104 (50.24%) of 207 patients with preoperative concurrent fibular pseudarthrosis developed an ankle valgus deformity compared with 36 (32.14%) of 112 patients without preoperative concurrent fibular pseudarthrosis (p=0.002). After adjusting for sex, body mass index, fracture age, age of patient undergoing surgery, surgery method, type 1 neurofibromatosis (NF-1), limb-length discrepancy (LLD), CPT location and fibular cystic change, patients with concurrent fibular pseudarthrosis presented a higher risk of ankle valgus than those without concurrent fibular pseudarthrosis (OR 2.326, 95% CI 1.345 to 4.022). This risk further increased with CPT location at the distal one-third of the tibia (OR 2.195, 95% CI 1.154 to 4.175), age <3 years of patient undergoing surgery (OR 2.485, 95% CI 1.188 to 5.200), LLD <2 cm (OR 2.478, 95% CI 1.225 to 5.015) and occurrence of NF-1 disorder (OR 2.836, 95% CI 1.517 to 5.303).

CONCLUSION

Our results indicate that patients with CPT and preoperative concurrent fibular pseudarthrosis have a significantly increased risk of ankle valgus compared with those without preoperative concurrent fibular pseudarthrosis, particularly in those with CPT location at the distal third, age <3 years at surgery, LLD <2 cm and NF-1 disorder.

摘要

背景

本研究评估了术前合并腓骨假关节与先天性胫骨假关节（CPT）患者成功手术后发生踝关节外翻畸形风险的相关性。

方法

回顾性分析 2013 年 1 月 1 日至 2020 年 12 月 31 日在我院接受治疗的 CPT 患儿。自变量为术前合并腓骨假关节，因变量为术后踝关节外翻。调整可能影响踝关节外翻风险的变量后，进行多变量逻辑回归分析。使用分层多变量逻辑回归模型进行亚组分析，以评估这种关联。

结果

319 例成功接受手术治疗的患儿中，140 例（43.89%）发生踝关节外翻畸形。此外，104 例（50.24%）术前合并腓骨假关节的患者发生踝关节外翻畸形，而 112 例（32.14%）无术前合并腓骨假关节的患者发生踝关节外翻畸形（p=0.002）。调整性别、体重指数、骨折年龄、手术时患儿年龄、手术方法、1 型神经纤维瘤病（NF-1）、肢体长度差异（LLD）、CPT 位置和腓骨囊性改变后，合并腓骨假关节的患者发生踝关节外翻的风险高于无合并腓骨假关节的患者（OR 2.326，95%CI 1.345 至 4.022）。当 CPT 位于胫骨远端三分之一处（OR 2.195，95%CI 1.154 至 4.175）、手术时患儿年龄<3 岁（OR 2.485，95%CI 1.188 至 5.200）、LLD<2cm（OR 2.478，95%CI 1.225 至 5.015）和 NF-1 障碍时（OR 2.836，95%CI 1.517 至 5.303），这种风险进一步增加。