| Objective:The proximal tibia dysplasiawhether have an affect on the Congenital pseudarthrosis of the tibia(CPT),which at the postoperative pseudarthrosis’ s bone healing,the bilateral lower extremity length,the tibia limb alignment and ankle eversion.Methods:The total number of cases CPT acquisition met the inclusion criteria for the 66 cases. The average age at surgery was 3.59±2.67 years old, mean follow-up time was3.55±1.29 years. There are 32 patients in the study group, which patients have accompanied by proximal tibia dysplasia. And in the controlgroup have 34 patients which don’t accompanied by proximal tibia dysplasia. The study group, 16 patients had proximal tibia trumpet-like changes, 14 cases of proximal tibial epiphyseal plate forward, 28 cases have front shin bone cortex depression, there are more than three changes tibia 10 cases. According to the X-ray evaluation criteria, postoperative patients were divided into healing, delayed union and nonunion by the image in the X-ray.Compared postoperative with postoperative by the X-ray film,measuring two groups patients limb shortening, ankle eversion and limb alignment circumstances. And observed the performance of re-fracture. Then comparing two groups of informationdata.Result:(1)In accordance with the modified Ohnishi X-ray evaluation of bone healing: The study group 32 patients achieve bone healing in 24 cases, 2 case of delayed union, nonunion 6 cases, the healing rate was 75.0%, the average healing time was 28.0±29.2 weeks.The control group of 34 patients achieve bone healing was 29 cases, 2 cases of delayed union, nonunion 3 cases, the healing rate was 85.3%, the average healing time was 24.8±23.0 weeks.This result that thepseudarthrosis of tibia’s healing rate and healing time both have the no difference(P> 0.05).(2)The bilateral lower extremity length methods of measurement Paley made to measure. Before the surgery, the study Group ipsilateral tibia average shortening 3.48±4.24 cm, group ipsilateral tibia average shortening 2.43±3.40cm;After surgery, the study group ipsilateral tibia average shortening 2.49±3.38 cm, group ipsilateral tibia average shortening 1.10±3.35 cm.This result that the bilateral lower extremity length in this two groups were no difference(P> 0.05).(3) Limb alignment:the patients which limb alignment in the terms of the a LDFA, has 7 cases in the study group,6 cases in the control group; in the terms of the MPDA, has 18 cases in the study group,14 cases in the control group; in the terms of the LDTP has 17 cases in the study group,15 cases in the control group.Preoperative tibia angulation of the study group patients’ tibia angulation average 18.1±14.4°,and the control group average 22.3±12.7°;,postoperative tibia angulation of the study group average 7.3±3.8°,and the control group average 5.6±6.5°.The two groups in MPTA angle and tibial angulation were differences(P <0.05);,AT the a LDFA, LDTP and the preoperative angular deformity which before surgery was no difference(P> 0.05).(4)Using Malhotra ankle eversion grading to assessment of the ankle eversion:the study group: 0 grade 2 cases, I grade 3 cases,Ⅱgrade 11 cases, Ⅲgrade 16 cases;the control group: 0 grade 4 cases, I grade 10 cases,Ⅱgrade 10 cases, Ⅲgrade10 cases; Two groups’ ankle valgus classification has a differences(P <0.05).(5)Fractures occur again:the control group has four cases, the study group has 6 cases.These groups again no difference in fracture incidence(P> 0.05).(6)Fibula pseudoarthrosis:the study group has 23 cases,the control group has 24 cases.Two groups’ fibula pseudoarthrosis was no difference(P> 0.05).Conclusion:1. Proximal tibial dysplasia in the combined surgery to treat CPT patients affect the postoperative tibial angled, ankle valgus deformity, and affect the postoperative the limb alignment of MPTA angle, too;2. Proximal tibial dysplasia in combined surgery to treat CPT, on the postoperative pseudarthrosis’ healing time and healing rate, fibula pseudoarthrosis rate, postoperative re-fracture rates, the limb alignment of a LDFA and LDTP’s angle has no effect. |
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