Ilizarov技术治疗创伤性膝关节屈曲挛缩畸形  

Management of postt aumatic flexion contracture in knee joint using llizarov technique

作　　者：杨胜松[1] 黄雷 滕星[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：《中华骨科杂志》2012年第5期462-466,共5页Chinese Journal of Orthopaedics

摘　　要：目的探讨采用Ilizarov技术治疗创伤性膝关节屈曲挛缩畸形的疗效。方法回顾性分析2006年1月至2010年12月采用Ilizarov技术治疗6例创伤后膝关节屈曲挛缩畸形男性患者的资料，年龄9-43岁，平均24．5岁；术前膝关节屈曲畸形35°-85°，平均47．6°；膝关节活动度0°-70°，平均15．8°。其中5例为膝关节陈旧性骨折伴马蹄足畸形，畸形角度为25°-37°，平均31．8°；1例为股骨髁上骨折。采用环型外固定架逐渐矫正屈膝和马蹄足畸形，其中4例因膝关节骨性结构严重破坏且软组织条件差，在膝关节恢复伸直位后行膝关节融合术；另2例膝关节恢复伸直位后，白天松开螺母活动膝关节，睡觉时将膝关节固定在伸直位，1个月后去除外固定架改长腿支具保护3个月。结果术后随访12-22个月，平均18个月。6例患者膝关节屈曲角度由术前47．67°±18．63°恢复到屈曲9.33°±3．50°。5例伴马蹄足畸形患者踝关节跖屈角度由术前31．80°±4．65°恢复到术后3．00°±4．47°。4例患者术后膝关节成功融合，2例膝关节活动度分别为30°和75°。术后6例患者均可拄手杖行走。术后2-4个月，4例患者出现针道感染，经口服抗生素及使用双氧水清洁针道后约2周感染控制。结论采用Ilizarov技术可有效治疗创伤后膝关节屈曲畸形。对膝关节骨性结构损伤且软组织条件较差的患者可行膝关节融合术。Objective To evaluate the effectiveness of correction of posttraumatic flexion contracture of knee （FCK） using Ilizarov technique. Methods Six male patients with posttraumatic FCK, aging from 9 to 43 years （mean, 24.5 years）, treated by using Ilizarov technique from January 2006 to December 2010, were retrospectively analyzed. The preoperative flexion deformity of knee ranged from 35° to 85° （mean, 47.6°）, and the range of motion ranged from 0° to 70° （mean, 15.8°）. Among them, five patients had old fracture of knee joint combined with equinus foot deformity （deformity ranging from 25° to 37°, with an average of 31.8°）; one patient had femoral supracondylar fracture. We used circular external fixator to cmTect the FCK and equinus foot deformity gradually, the knee arthrodesis operation was performed in 4 patients because of the damaged bone structure and poor soft tissue condition. Results All patients were followed up for 12-22 months （mean, 18 months）. The flexion of knee joint was recoverd from preoperative 47.67°±18.63° to postoperative 9.330±3.50°. Plantar flexion of ankle joint in five equinus foot deformity was recovered from preoperative 31.80°±4.65° to postoperative 3.000±4.47°. The knee joint was arthrodesised successfully in 4 patients and the other 2 patients got 30° and 75° ROM. All the patients can walk with a cane, and satisfied with the result of treatment. Pin-site infection was found in 4 patients and was controlled within two weeks. Conclusion Ilizarov technique is an effective treatment method for posttraumatic FCK. Knee arthrodesis should be performed when patients had damaged bone structure and poor soft tissue condition.

关 键 词：伊利扎罗夫技术 膝关节 外固定器 骨生成 牵拉 

分 类 号：R687.3[医药卫生—骨科学]