Ilizarov外固定架非对称性延长一期治疗股骨短缩合并重度膝外翻畸形  

Simultaneous treatment of asymmetric callus distraction by Ilizarov external fixator in young patients with serious valgus deformity of the knee companied with femoral shortening

作　　者：沙佳 徐会法[1] 严亚波[1] 李超[1] 黄鲁豫[1] 

机构地区：[1]第四军医大学西京医院骨科,西安710032

出　　处：《中国矫形外科杂志》2017年第4期297-302,共6页Orthopedic Journal of China

基　　金：国家自然科学基金资助项目(编号:81171735)

摘　　要：[目的]探讨运用Ilizarov外固定架非对称性延长术一期治疗严重膝外翻畸形合并股骨短缩的疗效,为临床选择合理的治疗方法提供依据。[方法]回顾性分析本院儿童骨科2006年1月~2015年4月采用Ilizarov外固定架对12例膝外翻畸形并肢体短缩患者行Ilizarov外固定架延长术治疗的资料。男4例,女8例,年龄13~21岁,平均16.5岁,均为单侧。术前患侧肢体短缩6~11 cm,平均8.40 cm;股胫角155°~135°,平均142°;踝间距15~43cm,平均28.20 cm。通过Paley法确定膝外翻矫形截骨平面(远端),根据截骨处骨质情况确定是否需要股骨近段截骨来延长股骨。本组病例均行单一股骨远端截骨Ilizarov外固定架非对称性延长术。[结果]全部患者均获随访。随访时间12~60个月,平均34个月,延长范围6~10 cm,平均7.90 cm。愈合后股胫角161°~169°,平均166°,患肢术后短缩-0.80~1.20 cm,平均0.30 cm,膝外翻及股骨短缩纠正满意,行走无疼痛,无骨不连及腓总神经损伤发生,术后有10例患儿出现膝关节伸屈受限,伸(0°)~屈(15°~90°),经过理疗锻炼后明显好转,达到伸(0°)~屈(60°~105°)。[结论]Ilizarov外固定架非对称性延长术一期治疗严重膝外翻畸形合并股骨短缩具有截骨愈合好、创伤小及并发症少等优点,是一种有效、可靠的方法。[Objective] To explore the efficacy of callus distraction technique with the llizarov external fixator for seriousvalgus deformity of the knee companied with leg shortening in young patients and to provide evidence for selecting reasonable therapy. [Methods] From January 2006 to April 2015, the clinical data of 12 young patients （4 males and 8 females, aged 13 to 21, mean age 16.5 years） treated with callus distraction, who had severe valgus deformity of the knee eompanied with femoral shortening, were analyzed retrospectively. All cases had unilateral valgus deformity of the knee, with a total of 12 knees. Before the operation, the abnormal limbs shortened from 6 to 11 cm （average 8.40 cm） compared with the normal one. The tibiofemoral angle ranged from 135°to 155° （mean angle 142°） and the Condyle interval from 15 to 43 cm （mean interval 28.20 cm） . The Paley method was used to determine the osteotomy plane （distal femur） of valgus deformity of the knee, and the bone conditions of the osteotomy determined whether or not we should use the method of proximal femoral osteotomy to extend the femur. In this group, all cases were performed with distal femoral osteotomy. [ Results] The 12 patients were followed up for 12 to 60 （mean 34） months. The extent length ranged from 6 to 10 cm （average 7.90 cm） . The tibiofemoral angle ranged from 161° to 169° （mean 166°） after the union. After the operation, the shortening length of lower limbs ranged from -0.80 to 1.20 cm （average 0.30 cm）, and the valgus deformity of the knee companied with femoral shortening had a satisfactory correction. All patients had first intention healing, without any surgical incision infection, pain after walking, bone nonunion, common peroneal nerve injury and other complications. The postoperative flexion range of the knee were restricted （15° - 90°） and extension 0° in the 10 cases, and after doing some physical manipulation and exercise the situation was improved significantly to knee joint flex

关 键 词：ILIZAROV外固定架 骨痂延长术 非对称性延长 膝外翻 骨短缩 

分 类 号：R687.3[医药卫生—骨科学]