Omokawa S, Tamai S, Takakura Y, Yajima H, Kawanishi K
Department of Orthopedic Surgery, Nara Medical University, Japan.
Microsurgery. 1996;17(3):162-6. doi: 10.1002/(SICI)1098-2752(1996)17:3<162::AID-MICR13>3.0.CO;2-Y.
We reviewed the long-term course of the donor-site ankle after vascularized fibula grafts in 13 children. The preventive and therapeutic effects of the tibio-fibular metaphyseal synostosis (T-F synostosis) against valgus ankle deformity, which is one of the postoperative donor-site problems, were evaluated based on three radiologic and clinical parameters. Thirteen patients were divided into two groups: patients with or without simultaneous T-F synostosis when the fibula was taken. Three patients underwent T-F synostosis secondarily after the development of the valgus deformity. Follow-up periods averaged 12.4 years. In the patients with primary T-F synostosis, valgus deformity was only observed in one case. No functional disorder of the ankle joints was observed after T-F synostosis. In the patients without T-F synostosis, all the patients younger than 8 years old showed valgus deformity, in which the tilting angle averaged 6.3 degrees. In the three patients who underwent T-F synostosis secondarily, the tilting angle normalized in cases in which the fixation was performed when the lateral wedging was in a mild stage. There was a statistically significant difference in valgus tilt angle between the two groups (with or without T-F synostosis).
我们回顾了13例儿童接受带血管腓骨移植后供区踝关节的长期病程。基于三个影像学和临床参数，评估了胫腓骨干骺端融合术（T-F融合术）对术后供区问题之一的踝关节外翻畸形的预防和治疗效果。13例患者分为两组：取腓骨时同时行或不行T-F融合术的患者。3例患者在出现外翻畸形后二次行T-F融合术。随访期平均为12.4年。在原发性T-F融合术的患者中，仅1例出现外翻畸形。T-F融合术后未观察到踝关节功能障碍。在未行T-F融合术的患者中，所有8岁以下患者均出现外翻畸形，倾斜角平均为6.3度。在3例二次行T-F融合术的患者中，在外侧楔形移位处于轻度阶段时进行固定的病例中，倾斜角恢复正常。两组（有或无T-F融合术）在外翻倾斜角方面存在统计学显著差异。
