摘要目的:探讨先天性胫骨假关节（congenital pseudoarthrosis of tibia，CPT）采用联合手术治疗愈合后腓骨的不同状态对临床结果的影响。方法:回顾性分析2010年1月至2014年12月于湖南省儿童医院（本研究为中国医科大学附属盛京医院小儿骨科与湖南省儿童医院骨科的联合研究）确诊为CPT且采用联合手术治疗获得骨性愈合的患儿52例，患儿手术时平均年龄为2.8岁，范围在0.8~7.9岁；术后平均随访时间为7.0年，范围在2.2~11.1年。根据CPT愈合后腓骨的不同状态将患儿分为腓骨完整组（24例）及腓骨假关节组（28例），比较两组的性别、是否合并Ⅰ型神经纤维瘤病（neurofibromatosis type Ⅰ，NF-1）、手术时年龄、随访时间、骨干成角、双侧胫骨长度差异及Johnston临床结果分级的差异，组间比较采用独立样本 t检验或Mann-Whitney U检验或卡方检验。采用Kaplan-Meier生存分析法比较两组间无骨折生存时间的差异。 结果:两组患儿性别、是否合并NF-1、手术时年龄、随访时间、骨干成角、双侧胫骨长度差异比较，差异均无统计学意义（均 P>0.05）。Kaplan-Meier生存分析法显示，腓骨完整组平均无骨折生存时间为113个月（95% CI：101~125个月），而腓骨假关节组平均无骨折生存时间为78个月（95% CI：62~94个月），两组患儿的无骨折生存率比较，差异有统计学意义（ P=0.022）。腓骨完整组临床结果Johnston Ⅰ级19例（79.2%，19/24）、Ⅱ级1例（4.2%，1/24）、Ⅲ级（再骨折）4例（16.7%，4/24）；腓骨假关节组临床结果Johnston Ⅰ级11例（39.3%，11/28）、Ⅱ级6例（21.4%，6/28）、Ⅲ级（再骨折）11例（39.3%，11/28）；临床结果分级组间比较，差异有统计学意义（ U=208.50， P=0.008）。 结论:CPT采用联合手术获得骨性愈合后保持腓骨的完整性能获得较好的临床结果。

abstractsObjective:To explore the efficacy of different post-union fibular statuses on clinical outcomes of congenital pseudarthrosis of tibia (CPT) treated with a combined surgery.Methods:Fifty-two children diagnosed with CPT and treated with a combined surgery with a bony union in the Hunan Children's Hospital from January 2010 to December 2014 were retrospectively recruited for analyses. The average age was 2.8 years (0.8-7.9 years). The mean postoperative follow-up period was 7.0 years (2.2-11.1 years). According to the different statuses of the fibula after the union of CPT, they were divided into the fibular integrity group (24 cases) and the fibular pseudarthrosis group (28 cases). Differences in gender, combining with neurofibromatosis type 1 (NF-1), age at operation, follow-up time, tibial diaphyseal angulation, tibial length discrepancy, refracture-free survival rate, and the UNC Health Johnston classification were compared between the two groups using independent sample t-tests, Mann-Whitney U test, and chi-squared test. The refracture-free survival time between the two groups was compared using Kaplan-Meier survival analysis.Results:There was no significant difference between the two groups regarding gender, NF-1, age at operation, follow-up time, tibial diaphyseal angulation, and tibial length discrepancy (all P >0.05). The average refracture-free survival time was 113 (95% CI: 101-125) months in the fibular integrity group, and 78 (95% CI: 62-94) months in the fibular pseudarthrosis group, showing a significant difference ( P=0.022). The UNC Health Johnston graded Ⅰ was rated in 19/24 cases (79.2%), grade Ⅱ in 1/24 case (4.2%), and grade Ⅲ (refracture) in 4/24 cases (16.7%) in the fibular integrity group, but grade Ⅰ in 11/28 cases (39.3%), grade Ⅱ in 6/28 cases (21.4%), and grade Ⅲ (refracture) in 11/28 cases (39.3%) in the fibular pseudarthrosis group. The difference in clinical outcomes grade between the two groups was statistically significant ( U=208.50, P=0.008). Conclusions:Preserving the fibular integrity can obtain good clinical outcomes after the union of CPT treated with a combined surgery.