不同类型延长器在胫骨延长术治疗双小腿不等长及身材矮小症的效果比较  

Comparing the curative effects of different external fixators in the tibia lengthening for inequality of lower limb or short statures

作　　者：杨华清[1] 夏和桃[2] 彭爱民[2] 王坤正[3] 党晓谦[3] 石文元[2] 韩义连[2] 

机构地区：[1]清华大学玉泉医院骨科,北京市100049 [2]北京骨外固定技术研究所,北京市100039 [3]西安交通大学第二医院骨科,陕西省西安市710004

出　　处：《中国临床康复》2006年第32期23-26,共4页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:观察不同类型延长器在胫骨上端截骨延长术中治疗双小腿不等长及身材矮小的效果,并分析各种延长器的优劣。方法:选择1998-02/2003-06清华大学玉泉医院骨科和北京骨外固定技术研究所及西安交通大学第二医院骨科收治的双小腿不等长患者4例和身材矮小患者27例为观察对象。对双下肢不等长患者采用Hoffman单臂外固定延长器;27例身材矮小患者中3例采用半环延长器延长,5例采用全环延长器延长,19例采用夏和桃内外结合系统延长器进行胫骨延长。①Hoffman单臂延长器:在截骨断端上、下交叉穿2组5mm骨圆针,在小腿前内侧安装单臂延长器。②Ilizarov全环延长器及半环延长器:截骨近端穿2组2mm克氏针,远端穿2组针,一组在距小腿(踝)关节上方10cm处;另一组靠近距小腿(踝)关节,其中1根针应穿过腓骨。③夏和桃内外结合系统延长器:带锁髓内钉手术入路——微创截骨——安放髓内钉——安装动态同步延长器。术后第8天开始延长,速度0.5～1.0mm/d,平均0.65mm/d,分4～6次进行延长。术后2周酌情要求患者扶助行器下床部分负重行走锻炼以及器械上的功能运动,为新骨提供应力刺激。每隔15天拍X射线片1次,3次以后,每隔1个月拍片1次,观察延长情况及并发症的严重程度等指标,治疗时间8～15个月。解除外固定时临床和X射线标准为骨痂形态成熟、骨痂填塞完全、没有缺损的钙化、髓腔贯通及新形成骨强度能支持行走而无骨折危险。结果:随访时间3～8年,31例患者全部获得连续随访,随访率100%。①采用单臂延长器延长,皮肤瘫痕大,并发症严重,最大延长幅度不超过4cm。②半环形延长器延长超过4cm将产生严重的足下垂。③Ilizarov全环延长器延长幅度可达10cm,易发生足下垂。④夏和桃内外结合系统延长器延长幅度可超过10cm,并发症较轻。结论:单臂延长器的延长效果差,不宜用于下�AIM： To observe the therapy effect of different external flxators in the tibia lengthening to treat inequality of lower limb or short statures, analyze advantage and disadvantage of different external fixators. METHODS：From February 1998 to June 2003 4 patients with inequality of lower limb and 27 patients with short statures who were treated at the Department of Orthopaedics, Yuquan Hospital, Tsinghua University, Beijing Institute of External Skeletal Fixation Technology, Department of Orthopaedics, Second Hospital, Xi ＇an Jiaotong University were enrolled as observational objects. Patients with inequality of lower limb were subjected to Hoffman ane-arm external fixators. Among the 27 patients with short statures, 3 patients received semi,ring fixators; 5 patients received full-ring fixators; 19 patients received Xiahetae external and intramedullary lengthening fixators. ①Hoffman one-ann fixators： Threading two group 5 mm round osseous pin crossing in the amphi broken-end osteotomy, and one-arm fixators were installed in leg anteriomedialis. ②Ilizarov full-ring fixators and semi-ring fixators：Threading two group 2 mm Kirschner wire in the proximate osteotomy, and 2 group needle in the distal end. One was in the 10 cm upper to ankle joint, and another was in the distal end of 10 cm proximal ankle-joint. Of them, one needle crossed fibular bone. ③ Xiahetae external and intramedullary lengthening fixators： operative approach of intramedullary locking nail-microwound osteotomy-implanting bone nail-installing dynamic state synchronous lengthening device. The limbs were lengthened at a speed of 0.5-1.0 mm per day starting from the 8^th day after the operation, averagely 0.65 nun per day, 4-6 times a day. Proper weight-loading exercise with walker and functional movement on instrument were done during the process of limb lengthening to stimulate the newly formed bone two weeks after operation. X-ray actinogram was gained once every 16 day, and X-ray actinogram was taken once every 2 month after 3 ti

关 键 词：胫骨延长 外固定延长器 并发症 

分 类 号：R714.257[医药卫生—妇产科学]