A Combined Surgical Technique For The Treatment Of Congenital Pseudarthrosis Of The Tibia: A Middle-term Result

Objective:To evaluate the middle-term outcome of a combined surgicaltechnique,which includes sleeve resection of the pathological soft tissues, retrogradeintramedullary rodding,packaged lilac bone autograft,and llizarov external fixation,for the treatment of congenital pseudarthrosis of the tibia(CPT).Methods:We reviewed23cases of congenital pseudoarthrosis of the tibia whowere treated with a integration of sleeve resection of the pathological soft tissues,retrograde intramedullary rodding, packaged iliac bone autograft,and llizarov externalfixation in our center from March,2007to April,2009.The mean age at surgery was3.6years(range,10months to9years and2months).According to Crawfordclassification,3cases were typeⅡ, and20cases were type Ⅳbefore the indexsurgery.And20cases associated with type1neurofibromatosis(NF1),while19cases hadfibular lesion.At a mean follow-up of5.7(range,5.1to7.1) years after the surgery, thepatients were evaluated clinically and radiographically. And we used Johnston clinicalevaluation system and improved Ohnishi x-ray grading standards to assess theoutcome.Results:All the cases were achieved bony union after the combined surgery,andaccording to improved Ohnishi x-ray evaluation,20cases reached union,1case showeddelayed union,and2cases were nonunion.And the average time of healing was3.7(3.7±0.5)months，among the20improved Ohnishi union cases.14cases had tibialmalalignment(while angulations above5°was counted).3cases had severe limb lengthdiscrepancy which was more than4cm.3cases occured refrature.There were3casesconfronted gradeⅠ a nkle valgus,while4caseswere grade Ⅱand15cases weregradeⅢ,based on Malhotra classification.Concering about the ankle function,1casehad ankle stiffness.Furthermore,Johnston clinical evaluation indicated that15casesreached grade1,7cases showed grade2,and1cases hit grade3. Our result of union rateis similar to that of the literatures reported recently,but we had fewer complications,especially in refracture.Conclusions:The combined surgical technique is a valid method for the treatment ofcongenital pseudoarthrosis of the tibia,and is also effective for those whom remainedfailure after multiple operations.As the course of CPT lasts until skeletal maturity,thelong-term effectivity of this combined surgical procedures still needs a long timeobservation.