Ilizarov技术治疗四肢畸形并发症分析  

Analysis of complications using the llizarov technique in the correction of limb deformities

作　　者：焦绍锋[1] 秦泗河 王振军[1] 任龙喜[1] 郭保逢[1] 

机构地区：[1]北京市垂杨柳医院矫形外科,100022

出　　处：《中华骨科杂志》2012年第3期245-248,共4页Chinese Journal of Orthopaedics

摘　　要：目的探讨Ilizarov技术治疗四肢畸形并发症的发生原因及防治经验。方法回顾性分析2000年1月至2010年10月采用Ilizarov技术治疗并获随访的846例各种四肢畸形患者的病例，男508例，女338例；年龄1．2-72岁，平均25．7岁；上肢畸形16例，下肢畸形830例。对治疗过程中（术中、术后）出现的并发症的种类、严重程度、处理方法和结果进行统计学分析。结果随访时间6-30个月，平均18个月。846例患者中，190例出现并发症，其中针道感染81例，关节活动障碍36例，皮肤热损伤6例，神经、血管损伤7例，骨延迟愈合8例，小腿骨筋膜间室综合征2例，关节脱位7例，断针5例，继发关节畸形8例，严重骨质疏松5例，皮疹6例，外固定器近端股骨干骨折4例，外固定器拆除后再骨折3例，畸形复发11例，其他1例。采用抗感染、功能训练、理疗、再次手术等方法进行对症处理，最终仍有13例遗留永久性功能障碍。结论应用Ilizarov技术在术前准备、手术操作、术后处理的各个环节均可出现多种问题与并发症。减少并发症发生的主要措施是，临床医生在应用Ilizamv技术前需要进行严格、系统培训，掌握手术适应证，理解Ilizarov技术原理，术前组装好个体化外固定器，严格遵循标准化手术操作与术后处理程序。Objective To analyze the causes of the complications in the treatment of limb deformi- ties with the Ilizarov technique and to discuss the management and prevention of these complications. Meth- ods From January 2000 to October 2010, 846 patients with limb deformities （16 upper limbs and 830 lower limbs） who had been treated with Ilizarov technique were retrospectively analyzed, including 508 males and 338 females with an average age of 25.7 years （range, 1.2-72）. Statistical analysis was used to compare the type, severity, treatment methods and results of complications. Results Postoperative follow-up lasted for 6 to 30 months, with an average of 18 months. There were 81 cases of pin tract infections, 36 cases of restrict- ed joint movements, 6 cases of skin thermal damage, 7 cases of nerves and vessels injury, 8 cases of bone delayed union, 2 cases of osteofascial compartment syndrome, 7 cases of dislocation, 5 cases of fixed needle breakage, 8 cases of secondary joint deformities, 5 cases of serious osteoporosis, 6 cases of skin eruption, 4 cases of femoral t^actures near to proximal external fixator, 3 cases of subsequent fracture after external fixa- tor dismantled, 11 cases of deformity recurrence and 1 case of the others. Combining with anti-infection, functional training, physiotherapy, and the second operation therapy and so on, a permanent disability was fi- nally left in 13 patients. Conclusion If the Ilizarov technique was used improperly, there would be multiple complications during the preoperative preparation, surgical procedures and postoperative management. Effec- tive preventive measures should be taken, such as following the principle of the Ilizarov technique, standardizing operation procedures, strictly postoperative observation, correcting postoperative rehabilitation exercise guidance, regular follow-up radiography and postoperative adaptability dynamic adjustment of the external technique.

关 键 词：伊利扎罗夫技术 四肢 畸形 手术中并发症 手术后并发症 

分 类 号：R687.3[医药卫生—骨科学]