有限矫形手术结合骨外固定技术治疗中老年脊髓灰质炎后遗症  

Limited orthopaedic surgery combined with external fixation for the treatment of lower extremity sequelae of middle and old aged post-poliomyelitis

作　　者：秦泗河 郭保逢 郑学建 焦绍锋 臧建成 QIN Sihe;GUO Baofeng;ZHENG Xuejian;JIAO Shaofeng;ZANG Jiancheng(l.Department of Orthopaedics,Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids,Beijing,100176,P.R.China;Department of Orthopaedics,ChuiYiangLiu Hospital Affiliated to Tsinghua University,Beijing,100022,P.R.China)

机构地区：[1]国家康复辅具研究中心附属康复医院矫形外科,北京100176 [2]清华大学附属垂杨柳医院矫形骨科,北京100022

出　　处：《中国修复重建外科杂志》2018年第10期1249-1254,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的总结应用有限矫形手术结合骨外固定技术治疗中老年脊髓灰质炎后遗症的临床疗效,探讨中老年脊髓灰质炎后遗症外科矫正与功能重建策略。方法从秦泗河矫形外科团队1982年9月—2017年12月手术治疗的23 310例脊髓灰质炎后遗症病例数据库中,检索出41岁以上患者629例,分析患者流行病学特点;并对其中2011年3月—2015年6月应用有限手术结合外固定技术治疗的57例获完整随访患者的临床资料进行回顾分析。57例患者脊髓灰质炎后遗症病史41~67年,平均47.1年。术前病理步态包括压股步态29例,扶拐行走17例,徒手跛行11例。手术方式包括跟腱延长术52例、股骨髁上截骨术39例、屈膝松解术36例、跟距关节融合术27例、屈髋松解术21例、胫腓骨截骨术19例、三关节融合术11例和肌腱转位术1例。术后应用组合式外固定器18例,应用Ilizarov环式外固定器39例。结果 629例患者中<50岁481例(76.47%),51~65岁144例(22.89%);其中2003年以后就诊患者495例(78.70%)。57例获随访2~6年,平均37个月。牵拉矫形期间发生针道轻度感染7例,术后早期下肢静脉血栓形成2例,腓总神经不全麻痹2例。无皮肤切口感染、血管损伤与骨不愈合等并发症发生。末次随访时根据下肢畸形矫治术后疗效随访评价标准,获优23例、良20例、可12例、差2例,优良率75.44%;2例评价为差的患者经实施二次手术改善部分功能。结论有限矫形手术结合骨外固定技术治疗中老年脊髓灰质炎后遗症,能有效矫正下肢畸形与改善功能,延缓衰变所加重的残障,能规避严重并发症。Objective To summarize the effectiveness of limited orthopedic surgery combined with external fixation for the treatment of lower extremity sequelae of middle and old aged post-poliomyelitis, and then to explore the strategy of surgical correction and functional reconstruction method. Methods From the database of 23 310 cases of poliomyelitis sequelae treated by QIN Sihe Orthopaedic Surgical team between September 1982 and December 2017,629 patients over 41 years old were retrieved and the epidemiological characteristics of the patients were analyzed.Between March 2011 and June 2015, 57 patients with poliomyelitis sequelae treated with limited operation and external fixation were followed up 2-6 years, and the history of poliomyelitis sequelae was 41-67 years（mean, 47.1 years）.Preoperative histopathological gait included 29 cases of quadriceps gait, 17 cases of walking with crutch, and 11 cases of claudication only. The operative methods included Achilles tendon lengthening in 52 cases, supracondylar osteotomy in39 cases, knee flexion release in 36 cases, calcaneal arthrodesis in 27 cases, flexion and hip arthrodesis in 21 cases, tibia and fibula osteotomy in 19 cases, triple arthrodesis in 11 cases, and tendon transposition in 1 case. After operation, 18 cases were treated with combined external fixator and 39 cases with Ilizarov ring external fixator. Results Of the 629 cases, 481 cases were less than 50 years old（76.47%）, accounting for 144 cases between 51 and 65 years old（22.89%）. Among them, 495 cases（78.70%） were diagnosed after 2003. Of the 57 patients obtained complete follow-up information, 7 had slight infection of needle path during traction orthopaedics, 2 had early postoperative venous thrombosis of lower extremities, and 2 had incomplete paralysis of the common peroneal nerve. There was no complications such as skin incision infection, vascular injury, and bone nonunion. According to the evaluation standard of postoperative efficacy standard in correction of lower extremity deformit

关 键 词：有限矫形手术 骨外固定技术 中老年 脊髓灰质炎后遗症 

分 类 号：R687.3[医药卫生—骨科学]