Analysis Of Risk Factors For Refracture After Union Of Congenital Pseudarthrosis Of The Tibia With A Combined Surgical Technique

Objective: To explore the factors related with refracture after union of congenital pseudarthrosis of the tibia with a combined surgical and provide an important reference for clinical treatment.Methods: From April 2007 to August 2011,cases of clinical data collected from patients with congenital pseudarthrosis of the tibia in the Hunan Province Children's Hospital,followed up deadline was August 2016,in accordance with the inclusion criteria of 40 cases who were applied survival analysis respectively on gender,whether or not fusing of Neurofibromatosis type 1(NF1)and ankle joint was fixed,operative age,fibular status and the cross-sectional area ratio of healing site.COX proportional hazards regression analysis the factors found to be statistically significant by Log-rank analysis.Results:(1)No significant inter-group differences existed in gender or whether or not fusing of NF1 and ankle joint was fixed.(2)In operative age ? 3 years group whose refracture-free survival was significantly better in those less than 3 years(mean refracture-free period was 69.2months vs 40.7 months,median refracture-free period was 76.0 months vs 49.0 months,P<0.05).(3)Intact fibula or stabilised by tibiofibular synotosis or Kirschner wire group showed significantly better refracture-free survival than those with a pseudarthrotic fibula due to neglect or failed synostosis(mean refracture-free period was 69.1 months vs 30.0 months,median refracture-free period was 76.0 months vs 16.0 months,P<0.05).(4)There was significant difference between ankle joint fixed group and ankle joint unfixed group(mean refracture-free period was 22.9 months vs 69.6 months,median refracture-free period was 11.0 months vs 76.0 months,P<0.05).(5)With a cross-sectional area median ratio of healing site of 0.15,refracture-free survival was significantly better than those with a lesser value(mean refracture-free period was 74.0 months vs 35.3 months,median refracture-free period was 76.0 months vs 43.0 months,P<0.05).(6)COX proportional hazards regression analysis: there was a negative correlation between the cross-sectional area and refracture occurred(?=-1.989,P < 0.05),fibular pseudarthrosis and refracture occurred were positively correlated(?=1.506,P < 0.05),operative age and ankle joint status had no relationship with refracture occurred(P > 0.05).Conclusions: The main risk factors of related with refracture after union of congenital pseudarthrosis of the tibia with a combined surgical were the smaller cross-sectional area ratio of healing site and fusing of fibular pseudarthrosis.For a longer healing time and a better long-term bone union rate,cross-sectional area of pseudarthrosis healing site should be as large as possible and fibular pseudarthrosis need be stabilized.