Ilizarov外固定架治疗创伤性马蹄足  

Treatment of equinus deformity with Ilizarov fixator

作　　者：黄雷 张建立[1] 王慎东 范丰川[1] 王金辉[1] 张伯松[1] 尹彦军 王满宜[1] 

机构地区：[1]北京积水潭医院创伤骨科,100035 [2]山东新汶矿务局中心医院

出　　处：《中华创伤骨科杂志》2006年第5期411-414,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨应用Ilizarov外固定支架治疗创伤性马蹄足的疗效。方法2003年2月～2005年8月应用Ilizarov外固定架治疗17例创伤所致马蹄足患者。将组装好的Ilizarov外固定架按照Ilizarov的穿针固定原则安装在患侧小腿和足部。术后3d开始转动螺纹杆上的螺母,第1周旋转螺母2～4圈/d,4次/d;1周后旋转螺母1～2圈/d,4次/d,分别逐渐缩短和延长前、后螺纹杆,矫正马蹄足畸形。用伊氏架将踝关节固定在中立位2～3个月。去除外固定架后让患者逐渐增加负重量直至完全负重。不负重时穿戴支具保持踝关节处于中立位至少3个月。结果17例患者均得到随访,平均随访10个月(7～14个月)。术后4～6周踝关节恢复到中立位。平均带外固定架14.5周(10～16周)。无血管、神经损伤。3例各1处针道轻度感染,对症处理后感染消失。1例诉矫正过程中疼痛,术后10周去除外固定架,去除外固定架后6周时僵直在跖屈20°。1例去除外固定架4个月后僵直在跖屈10°。1例小腿前后肌群损伤严重合并胫骨骨缺损重建术后踝关节矫正到中立位后1.5个月行踝关节融合术,融合术后3个月去除外固定架。其余14例达到0°全足负重,行走时无明显足下垂。2例负重时疼痛。踝关节背伸肌群功能存在的患者,踝关节可主动背伸10°。结论Ilizarov外固定架是治疗创伤性马蹄足的微创技术。Objective To evaluate the treatment of equinus deformity with Ilizarov fixator. Methods From February 2003 to August 2005, 17 patients with traumatic equinus were managed with Ilizarov fixator in our department. A preoperatively constructed ring fixator was applied on the involved foot and leg. Three days after the fixation, the compression threaded rod in the front and the distraction threaded rod at the back were respectively shortened and lengthened by turning the screw nuts on the rods 2 to 4 rounds in four times per day in the first week, and then 1 to 2 rounds in four times per day, which resulted in gradual correction of equinus deformity. The Fixation was maintained in neutral position for 2 to 3 months after achieving sufficient equinus correction to ensure the state of dorsiflexion. An ankle-foot orthosis was applied during resting and sleeping for more than three months after removal of the fixator. Results The mean follow-up period was 10 months （range, 7 to 14）. All the patients achieved 0° dorsiflexion 4 to 6 weeks after the treatment while in the Ilizarov apparatus. The fixator was maintained in patients for an average of 14, 5 weeks （ 10 to 16 weeks）. No blood vessel or nerve was injured. Three patients had one mild pin track infection which responded to conventional management. A 20° equinus contracture reoccurred to one patient six weeks after the removal of the apparatus which had been maintained only for 10 weeks because the patient noted severe pain with the apparatus. One patient chose to accept his improved but persistent 10° equinus contracture. One patient who had had reconstructive surgery for his severely damaged leg muscles and tibial defect eventually required tibiotalar arthrodesis. Entire foot weight bearing with zero angle and walking without significant footdrop were achieved in the other 14 cases. Two patients complained of pain while bearing weight. Active ankle dorsiflexion of 10° beyond the neutral position was achieved in patients with functioning ankle dorsal ext

关 键 词：伊利扎罗夫技术 马蹄足 外固定支架 

分 类 号：R687.3[医药卫生—骨科学] R682.6[医药卫生—外科学]