应用单边外固定支架矫正胫骨近端内翻畸形  

Treatment of proximal tibial varus malunion with a unilateral external fixator

作　　者：滕星[1] 黄雷 杨胜松[1] 赵刚[1] 王满宜[1] 

机构地区：[1]北京积水潭医院创伤骨科,100035

出　　处：《中华创伤骨科杂志》2011年第6期517-521,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨应用单边外固定支架矫正胫骨近端内翻畸形的疗效。方法2004年7月至2010年8月应用单边外固定支架治疗5例胫骨近端内翻畸形患者，男2例，女3例；年龄18～42岁，平均32岁。胫骨平台骨折与胫骨近端骨折畸形愈合各2例，胫骨近端截骨延长后出现牵开骨痂的畸形愈合1例。术中对腓骨进行截骨，在胫骨安装外固定支架，并在胫骨近端进行截骨。术后7～10d通过外固定支架逐渐牵开并纠正成角畸形。结果所有患者术后获5。11个月（平均8．4个月）随访。1例患者牵开处不愈合，经植骨治疗后愈合；其余4例均愈合，愈合时间为3～6个月，平均4．8个月，带架时间为4～8个月，平均6．8个月。所有腓骨截骨端均愈合，针道除并发轻微反应外无严重并发症，手术与矫正过程中未出现神经损伤等并发症。机械轴偏向矫正后较健侧平均外移8mm（1～13mm）。胫骨近端内侧角矫正后平均为90°（87°～92°）。矫正后患侧肢体和健侧差异为-6—1mm，胫骨和健侧长度差异为-2～3mm。结论单边外固定支架能够成功矫正胫骨近端内翻畸形愈合，与传统的外翻截骨内固定相比，它具有创伤小、无需植骨及截骨方法简单的优点，逐渐矫正能获得更准确的力线，同时可矫正肢体短缩、避免再次手术。Objective To review gradual correction of proximal tibial varns malunion with a uni- lateral external fixator for osteogenetic distraction. Methods From July 2004 to August 2010, we treated 5 cases of proximal tibial varns malunion with a unilateral external fixator. They were 2 men and 3 women, with an average age of 32 years （from 18 to 42 years）. Two cases were malunion after tibial plateau fracture, 2 after proximal tibial fracture, and one after osteogenetic distraction. After fibular osteotomy, a tibia] uni- lateral external fixator was installed before proximal tibial osteotomy. Varus was corrected for 7 to 10 days after surgery by gradual distraction till the same alignment was obtained as the contralateral side. The external fixator was not removed until consolidation and full weight bearing. Results The follow-ups ranged from 5 to 11 months （average, 8.4 months）. Four cases got united after 3 to 6 months （average, 4.8 months）. Time for external fixator ranged from 4 to 8 months （average, 6.8 months） . One case obtained bone union after bone grafting. All fibulas healed after osteotomy. No other complications were present except mild pin-tract problems. Compared with the contralateral side, the corrected malalignment deviation was laterally displaced by 8 mm on average （from 1 to 13 mm）, the corrected medial proximal tibial angle was 90° on average （from 87° to 92°）, the limb length discrepancy was - 6 to 1 mm, and the tibial length discrepancy was - 2 to 3 mm. Conclusions Proximal tibial varus malunion can be corrected gradually and effectively by a unilateral external fixator. Its advantages over valgus osteotomy and internal fixation are less invasion due to simple transverse osteotomy, accurate correction not only of angulation but also of length discrepancy, and no need of bone grafting or implant removal.

关 键 词：胫骨骨折 截骨术 植骨 外固定器 

分 类 号：R687.3[医药卫生—骨科学]