微创截骨联合改良Ilizarov技术治疗重度先天性“O”型腿畸形的临床研究  

Clinical study of femoral and tibial minimally invasive osteotomy combined with modified Ilizarov technique in the treatment of severe congenital“O⁃leg”deformity

作　　者：周玉成 夏和桃[2] 胡军[3] 聂邦旭[3] 吴睿 王飞 张云峰 ZHOU Yu-cheng;XIA He-tao;HU Jun;NIE Bang-xu;WU Rui;WANG Fei;ZHANG Yun-feng(Department of Orthopaedics,the Disabled Persons Rehabilitation Center of Yunnan,Kunming 650011,China;Beijing Institute of External Fixation Technology,Beijing 100039,China;Department of Orthopaedics,the First People's Hospital of Kunming,Kunming 650011,China)

机构地区：[1]云南省残疾人康复中心骨科,昆明650011 [2]北京骨外固定技术研究所,北京100039 [3]云南省昆明市第一人民医院骨科,昆明650011

出　　处：《骨科》2021年第3期220-225,共6页ORTHOPAEDICS

摘　　要：目的评估股骨、胫骨微创截骨联合改良Ilizarov技术治疗重度先天性“O”型腿畸形的安全性和有效性。方法回顾性分析云南省残疾人康复中心2016年9月至2019年12月收治的13例重度先天性“O”型腿畸形病人的临床资料,其中男8例,女5例,年龄为(9.23±0.36)岁(4~26岁)。病人均采用股骨、胫骨微创截骨,股骨使用单侧三维外固定器固定,胫骨使用Ilizarov外固定器进行固定。术后测量病人的机械轴偏距(mechanical axis deviation,MAD)、股骨远端解剖轴外侧角(anatomic lateral distal femo⁃ral angle,aLDFA)、胫骨近端内侧角(medial proximal tibial angle,MPTA)、胫骨远端外侧角(lateral distal tibial angle,LDTA)、膝关节屈曲活动度。采用Paley功能评分标准评价患肢功能,记录骨愈合时间和并发症情况。结果13例病人截骨面全部骨性愈合,平均愈合时间为36周。病人术后下肢力线恢复较好,临床症状明显改善,根据Paley功能评分标准,优10例,良2例,中1例,优良率为92.3%,术后末次随访测量的MAD、aLDFA、MPTA、LDTA、膝关节屈曲活动度与术前比较,差异均有统计学意义(P均<0.05)。结论重度先天性“O”型腿采用股骨、胫骨微创截骨联合改良Ilizarov外固定技术可准确矫正畸形,获得相对理想的疗效,是临床上治疗重度先天性“O”型腿畸形的较好选择。Objective To evaluate the safety and effectiveness of minimally invasive femoral and tibial osteotomy combined with modified Ilizarov technique in the treatment of severe congenital“O⁃leg”deformity.Methods A total of 13 patients with severe congenital“O⁃leg”deformity admitted to the Disabled Persons Rehabilitation Center of Yunnan from September 2016 to December 2019 were selected.There were 8 males and 5 females,with an age of(9.23±0.36)years(4⁃26 years).The femur and tibia were given minimally invasive osteotomy,the femur was fixed with a unilateral three⁃dimensional external fixator,and the tibia was fixed with Ilizarov.The external fixing frame was used for fixation.The mechanical axis deviation(MAD),anatomic lateral distal femoral angle(aLDFA),medial proximal tibial angle(MPTA),lateral distal tibial angle(LDTA)and range of motion of knee were measured.Paley function score was used to evaluate the function of the affected limb,and bone healing time and complications were recorded.Results The average healing time of the osteotomy face in 13 cases was 36 weeks,and all bones healed.The patients were recovered well after the operation,and the clinical symptoms were significantly improved.According to the Paley function scoring standard,1 case recovered moderately,2 cases recovered well,10 cases recovered excellently,and the recovery rate accounted for 92.3%.There were significant differences in MAD,aLDFA,MPTA,LDTA,range of motion of knee measured at the last postoperative follow⁃up compared with those before operation(all P<0.05).Conclusion For severe congenital“O⁃legs”,the femoral and tibial minimally invasive osteotomy combined with modified Ilizarov external fixation technology can accurately correct the deformity,and relatively ideal clinical effects can be obtained.It is a better choice for the treatment of severe congenital“O⁃leg”deformities in clinic.

关 键 词：ILIZAROV技术 外固定器 张力-应力法则 微创截骨 “O”型腿畸形 

分 类 号：R687.3[医药卫生—骨科学]