摘要
背景:小腿严重伤害时,肌肉挛缩导致僵硬的膝关节屈曲畸形和马蹄足畸形,传统的治疗手段往往无法取得满意的疗效且容易导致严重的后果。目的:观察Ilizarov技术矫治小腿肌挛缩导致膝及足踝部畸形疗效。设计、时间及地点:回顾性病例分析,2002-05/2008-01北京市垂杨柳医院矫形外科。对象:应用Ilizarov技术牵伸治疗小腿肌肉挛缩导致的足、踝及膝关节畸形23例。男13例,女10例;年龄13～31岁,平均19.5岁;左下肢13例,右下肢10例。方法:术前测量畸形角度、大腿和小腿的最大直径以及足的大小。根据肢体的情况,挑选牵伸器组件,组装好有个体化特征的Ilizarov牵伸器大体框架。术中进行有限的软组织松解或仅根据畸形部位及情况安装牵伸器。术后缓慢牵伸(0.5～1.0mm/d),逐渐矫正畸形并适当过牵,使畸形得到良好的矫正。主要观察指标:①畸形的角度及矫正情况。②关节的活动度变化。③并发症发生情况。结果:23例中,13例残留畸形小于5°,关节活动度与对侧正常关节比较相差小于10°,没有并发症;8例残留畸形小于15°,关节活动度与治疗前比较没有差异,仅有轻微的并发症不影响治疗结果;5例残留畸形小于30°,关节活动度与治疗前比较差异不大,有影响较大的但是短暂的并发症,或并发症较轻但需要后续手术。牵伸过程中,1例发生股骨干的骨折,6例关节轻度脱位,经及时调整牵伸器后最终矫正效果满意。19例平均随访34个月,7例畸形有所复发,其中角度进展大于20°5例,角度进展大于30°2例,均应用支具继续治疗。结论:应用Ilizarov技术及原理,经皮穿刺针在膝关节上下或足踝部安装具有个体化特征的外固定牵伸器,通过缓慢的机械牵伸,可以使膝关节及踝足屈曲畸形得到逐渐的矫正。
BACKGROUND： After severe leg injury, muscular contractures can cause rigid deformities of knee flexion and clubfoot. Traditional therapy cannot achieve favorable effect even leads to severe results.
OBJECTIVE： To observe the therapeutic effect of Ilizarov technique for correcting deformities of knee and ankle-foot secondary to muscular contracture of the leg.
DESIGN, TIME AND SETTING： Retrospective analysis of cases was performed at Department of Orthopaedic Surgery, Chuiyangliu Hospital from May 2002 to January 2008.
PARTICIPANTS： Twenty-three patients with deformities of knee and ankle-foot secondary to muscular contracture of the leg were treated by Ilizarov＇s distraction, including 13 males and 10 females aged 19.5 years （range 13 31 years）, and 13 patients in the left lower limbs, and 10 patients in the right lower limbs.
METHODS： Before operation, angle of deformities, maximum diameter of the thigh and the leg, and size of the foot were respectively detected. According to deformity sign of the limb, components of the orthoterion were selected, and the framework of distraction apparatus with individual character was assembled. During the operation, local soft tissues were probably released, or the orthoterions were only installed on the deformity parts of the limb. Slow post-operative distraction （0.5-1.0 mm/d）, gradually corrected the extremity malformations and kept properly over-correction of the malformations to achieve ideal treatment effect.
MAIN OUTCOME MEASURES： Angulation of the deformities and degree of correction; range of joint motion; complications.
RESULTS： Of 23 patients, residual deformity was 〈 5° in 13 patients with slight differences in range of motion between affected limbs and normal joint （〈 10°）; residual deformity was 〈 15° in 8 patients with no differences in range of motion between affected limbs and normal joint but mild complications that could no affect treatment effect; residual deformity was 〈 30° in 5 patients with no differences in range of motion between affected limbs and normal joint but brief complications that were treated by secondary operation. During distraction, the femoral shaft fracture occurred in one patient, mild subluxation in 6 cases, which was corrected through immediately adjusting the orthoterion. Nineteen cases were followed up for 34 months. Seven patients developed recurrence of the deformities, progressive angulation 〉 20° in 5 cases, and 〉 30° in 2 cases. All these patients were treated using orthosis.
CONCLUSION： Based on Ilizarov＇s technique and principle, the individualized designed external distraction apparatuses are fixed around the knee and the ankle-foot by transcutaneous steel pins. Slow mechanical distraction gradually corrects the flexion deformities of the knee and clubfoot.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2008年第39期7636-7640,共5页
Journal of Clinical Rehabilitative Tissue Engineering Research
基金
北京市优秀人才资助项目(20041D090010)~~
