發(fā)布時間：2018-01-26 11:56

  本文關(guān)鍵詞： 先天性脛骨假關(guān)節(jié) 脛骨近端發(fā)育不良 愈合率 下肢力線 踝外翻畸形　出處：《南華大學》2015年碩士論文　論文類型：學位論文

【摘要】：目的:研究脛骨近端發(fā)育不良是否影響先天性脛骨假關(guān)節(jié)的假關(guān)節(jié)愈合,以及是否影響先天性脛骨假關(guān)節(jié)術(shù)后脛骨不等長、脛骨力線及踝外翻。方法:采集的符合納入條件的CPT病例總數(shù)為66例,平均手術(shù)年齡為3.59±2.67歲,平均隨訪時間為3.55±1.29年。其中研究組32例,為伴有脛骨近端發(fā)育不良的CPT患者;對照組34例,為不伴有脛骨近端發(fā)育不良的CPT患者。研究組中16例有脛骨近端喇叭狀改變,14例有脛骨近端骺板前傾,28例有脛骨前方皮質(zhì)凹陷,有以上三種脛骨改變的有10例。根據(jù)改良Ohnishi X線評價兩組患者脛骨假關(guān)節(jié)的愈合情況。按照Paley提出的測量方法測量兩組患者術(shù)前與術(shù)后的脛骨不等長長度、術(shù)后脛骨力線角度。統(tǒng)計兩組患者術(shù)后再骨折發(fā)生情況。兩組得到的結(jié)果通過統(tǒng)計學對比分析。結(jié)果:(1)按照改良Ohnishi X線評價骨愈合情況:研究組32例患者中達到骨愈合的為24例,延遲愈合2例,不愈合6例,愈合率為75.0%,平均愈合時間為28.0±29.2周。對照組34例患者中達到骨愈合的為29例,延遲愈合2例,不愈合3例,愈合率為85.3%,平均愈合時間為24.8±23.0周;兩組脛骨假關(guān)節(jié)愈合率與愈合時間無差異(P0.05)。(2)按照Paley提出的測量方法測量兩組患者術(shù)前與術(shù)后脛骨不等長的長度:術(shù)前研究組患側(cè)脛骨平均短縮3.48±4.24cm,對照組患側(cè)脛骨平均短縮2.43±3.40cm;術(shù)后研究組患側(cè)脛骨平均短縮2.49±3.38cm,對照組患側(cè)脛骨平均短縮1.10±3.35cm。兩組術(shù)前與術(shù)后脛骨不等長均無差異(P0.05)。(3)按照Paley提出的測量方法測量下肢力線:兩組患者力線角度異常在股骨遠端外側(cè)解剖角(a LDFA)中研究組7例,對照組6例;脛骨近端內(nèi)側(cè)角(MPTA)中研究組18例,對照組14例;脛骨遠端外側(cè)角(LDTP)中研究組17例,對照組15例;兩組脛骨成角畸形術(shù)前研究組平均為18.1±14.4°,對照組平均為22.3±12.7°,術(shù)后研究組平均為7.3±3.8°,對照組平均為5.6±6.5°。兩組在MPTA角度及脛骨成角畸形有差異(P0.05);在a LDFA、LDTP及術(shù)前成角畸形無差異(P0.05)。(4)采用Malhotra踝外翻分級標準評估踝外翻:對照組:0級4例,I級10例,Ⅱ級10例,Ⅲ級10例;研究組:0級2例,I級3例,Ⅱ級11例,Ⅲ級16例。兩組踝外翻分級有差異(P0.05)。(5)再骨折:研究組6例,對照組4例。兩組再骨折發(fā)生率無差異(P0.05)。(6)腓骨假關(guān)節(jié):對照組23例,研究組24例。兩組腓骨假關(guān)節(jié)發(fā)生率無差異(P0.05)。結(jié)論:1、脛骨近端發(fā)育不良對聯(lián)合手術(shù)治療CPT患者的脛骨成角角度、脛骨力線之MPTA角度以及踝外翻畸形有顯著影響;2、脛骨近端發(fā)育不良對聯(lián)合手術(shù)治療CPT患者的假關(guān)節(jié)的愈合時間、愈合率、腓骨假關(guān)節(jié)發(fā)生率、再骨折發(fā)生率、脛骨力線之a(chǎn) LDFA及LDTP角度無影響。
[Abstract]:Objective: to study whether proximal tibial dysplasia affects the healing of pseudoarthrosis and the unequal length of tibia after congenital pseudarthrosis of tibia. Methods: 66 cases of CPT were collected and the mean operative age was 3.59 鹵2.67 years. The mean follow-up time was 3.55 鹵1.29 years. 32 cases in study group were CPT patients with proximal tibia dysplasia. In the control group, 34 cases were CPT patients without proximal tibial dysplasia. In the study group, there were 14 cases with proximal tibial trumpet changes and 28 cases with anterior cortical depression of the tibial proximal epiphyseal plate. According to modified Ohnishi, there were 10 cases with the above three tibial changes. X ray was used to evaluate the healing of the pseudarthrosis of tibia in both groups. The length of tibia before and after operation was measured according to the measurement method proposed by Paley. Postoperative tibial force angle. Statistics of the occurrence of postoperative refracture in both groups. The results obtained in the two groups were compared and analyzed statistically. Results: 1). Bone healing was evaluated by modified Ohnishi X-ray: 24 of 32 patients in the study group achieved bone healing. There were 2 cases of delayed healing and 6 cases of non-union, the healing rate was 75.0 and the average healing time was 28.0 鹵29.2 weeks. In the control group, 29 cases achieved bone healing and 2 cases delayed healing. The healing rate was 85.3 and the average healing time was 24.8 鹵23.0 weeks. There was no difference in the healing rate and healing time of tibial pseudarthrosis between the two groups. According to the measurement method proposed by Paley, the length of tibia was measured before and after operation in two groups: the average shortening of tibia was 3.48 鹵4.24 cm in the study group before and after operation. In the control group, the average shortening of the tibia was 2.43 鹵3.40 cm. The average shortening of tibia was 2.49 鹵3.38 cm in the study group. In the control group, the average tibia shortening was 1.10 鹵3.35cm.There was no significant difference in tibia length between the two groups before and after operation. To measure the force line of lower extremity according to the measurement method proposed by Paley: there were 7 cases in study group in which the angle of force line was abnormal in the lateral anatomic angle of distal femur. Control group (6 cases); There were 18 cases in the study group and 14 cases in the control group. There were 17 cases in the study group and 15 cases in the control group. The mean value of tibial angulation malformation was 18.1 鹵14.4 擄before operation, 22.3 鹵12.7 擄in control group and 7.3 鹵3.8 擄in postoperative study group. The average value of the control group was 5.6 鹵6.5 擄. There were significant differences in MPTA angle and tibia angulation between the two groups (P 0.05). There was no difference in LDTP and preoperative angular malformation (P0.05U. 4) Malhotra criteria were used to evaluate the valgus of the ankle: 4 cases of grade 0 in the control group. There were 10 cases of grade I, 10 cases of grade 鈪，

本文編號：1465543