外固定辅助内固定矫正膝关节周围畸形  

Correction of deformities around the knee joint using external fixator-assisted internal fixation

作　　者：舒衡生[1] 石博文[1] 沈义东 刘亚斌[1] 郭峰[1] 马信龙[1] Shu Hengsheng;Shi Bowen;Shen Yidong;Liu Yabin;Guo Feng;Ma Xinlong(Department of Orthopaedic Traumatology,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市天津医院创伤骨科,300211

出　　处：《中华骨科杂志》2019年第1期10-16,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨外固定辅助内固定即时矫正膝关节周围畸形的疗效和精准度。方法回顾性分析2014年1月至2018年3月,采用外固定辅助内固定术中即时矫正15例(17个骨节段)膝关节周围畸形患者资料,男6例,女9例;年龄21~60岁,平均39岁;膝内翻畸形9例,膝外翻畸形6例。15例患者存在不同程度的短缩畸形,即肢体不等长,短缩长度为5~22 mm,平均12 mm。术中均使用单边外固定支架作为辅助的临时固定;截骨确定力线恢复满意后,经皮插入钢板或髓内钉;截骨端内固定物固定牢固后再拆除辅助用的外固定支架。结果 术中15例患者中7例单纯行股骨截骨,6例单纯行胫骨截骨,2例同时行股骨和胫骨截骨;2个骨节段经皮插入髓内钉固定,15个骨节段经皮插入钢板固定。所有患者矫正畸形角度7°~22°,平均12.5°;其中膝内翻9例,矫正畸形角度10°~22°,平均17.6°;膝外翻6例,矫正畸形角度7°~13°,平均10.4°。截骨部位骨愈合时间2.5~5.0个月,平均3.5个月。15例患者均获得随访,随访时间8~48个月,平均23个月。机械轴偏移由术前8~55 mm,平均34.8 mm,纠正至术后0~15 mm,平均5.93 mm;股骨远端机械轴外侧角由术前66°~82°,平均76.1°,纠正至术后84°~90°,平均87.5°;胫骨近端内侧角由术前68°~80°,平均76.8°,矫正至术后86°~89°,平均87.8°。术后15例患者无一例出现深部感染及神经、血管损伤。结论 外固定辅助内固定技术既有微创、方便调控的优点,又避免了患者长期佩戴外固定支架的痛苦和并发症,可以精确、安全地术中即时矫正下肢膝关节周围的畸形.ObjectiveTo evaluate the clinical outcomes and correction accuracy of deformities around the knee joint using external fixator-assisted internal fixation (FAIF).MethodsFrom January 2014 to March 2018, data of 15 patients (17 bone segments) with deformities around the knee joint who had been corrected with external fixator-assisted internal fixation were retrospectively analyzed. There were 6 males and 9 females, with an average age of 39 years (range, 21-60 years). There were 9 patients with genu varus and 6 with genu valgus. All the 15 patients had shortening ranging from 5 to 22 mm, with an average of 12 mm. Unilateral external fixator was used to stabilize the osteotomy site intraoperatively until the satisfied mechanical axis was acquired. Then the plate or Intramedullary nail was inserted and fixed, the external fixator was removed after internal fixation.Results Femur osteotomy was done in 7 patients and tibia osteotomy was done in 6 patients, while 2 patients had osteotomy in both tibia and femur. Intramedullary nailing was used in 2 bone segments, and plate was used in 15 bone segments. The correction of angle ranged from 7° to 22°, with an average of 12.5°. The correction of the 9 cases of genua varus ranged from 10° to 22°, with an average of 17.6°. The correction of the 6 cases of genu valgum ranged from 7° to 13°, with an average of 10.4°. The mean time to achieve union of the osteotomy sites was 3.5 months (range, 2.5-5.0 months). All the 15 patients were followed up for 8-48 months (average, 23 months). The mechanical axis deviation (MAD) was 5.93 mm (range, 0-15 mm) after operation which was 34.8 mm (range, 8-55 mm) before operation. The mean post-operative mechanical lateral distal femoral angle (mLDFA) was 87.5° (range, 84°-90°) which was 76.1° (range, 66°-82°) before operation. The mean medial proximal tibia angle (MPTA) was 87.8° (range, 86°-89°) which was 76.8° (range, 68°-80°) before operation. There were no deep infection and neurovascular injury.Conclusion The FAIF not

关 键 词：膝内翻 膝外翻 外固定器 内固定器 

分 类 号：R687.4[医药卫生—骨科学]