基于Ilizarov技术的小腿延长术  

Lower leg lengthening based on Ilizarov technique

作　　者：秦泗河 郭保逢 杜辉[3] Qin Sihe;Guo Baofeng;Du Hui(Department of Orthopaedic Surgery,Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids,Beijing 100072,China;Department of Orthopaedics,Chuiyangliu Hospital Affiliated to Tsinghua University,Beijing 100022,China;Department of Orthopaedics,Beijing Jishuitan Hospital,Beijing 100030,China)

机构地区：[1]国家康复辅具中心附属康复医院矫形外科,北京100072 [2]清华大学附属垂杨柳医院矫形骨科,北京100022 [3]北京积水潭医院矫形骨科,100030

出　　处：《中华骨科杂志》2021年第11期720-727,共8页Chinese Journal of Orthopaedics

摘　　要：小腿延长术已有百余年历史,早期因延长装置及技术条件不成熟常出现严重的并发症。Ilizarov技术的出现使肢体延长术成为一种可控的手术,肢体延长术基于"Ilizarov效应",通过对活体组织进行缓慢、稳定、持续的牵拉实现组织再生,骨与软组织的再生延长结果与儿童肢体发育相似。目前小腿延长术以经典Ilizarov外固定器为主,中国化Ilizarov小腿外固定延长器和小腿跟腱弹性同步延长外固定架是国内应用代表,其他延长方案包括计算机辅助六轴外固定架、髓内钉辅助外固定架延长、延长后植入髓内钉以及国内尚未开展的单纯髓内钉延长系统。胫骨平台下5~6 cm处为截骨平面的经皮横断截骨术是目前国内最多应用的截骨方法,可最大限度地保留骨膜和髓内血运。超过4 cm的延长推荐小腿跟腱弹性同步延长支架,需要跟骨穿针固定。术后遵循张力-应力法则缓慢牵伸延长,根据固定性刚度动态调整原则逐步拆除延长器,预防和及时处理并发症。Lower leg lengthening has a history of more than 100 years.However,serious complications occurred in the early stage due to the immature device and technical conditions.The emergence of Ilizarov technology making limb lengthening is a kind of controlled operation.Based on the"Ilizarov effect",the results of limb regeneration and lengthening were obtained by slow,stable and continuous distraction of living tissues.The regeneration of bone and soft tissue is like limb development in children.Currently,the traditional Ilizarov external fixation is still the dominated method for leg lengthening.The Chinese Ilizarov external fixator and the lower leg Achilles tendon elastic lengthening external fixator are the representatives of domestic application.Other limb lengthening methods,including computer hexapod assisted orthopedic surgery(CHAOS),lengthening over nail(LON),lengthening and then nailing(LATN)and intramedullary nail lengthening system,have not been developed in China.Percutaneous transverse osteotomy at 5-6 cm below the tibial plateau is a common osteotomy method in China.This method can maximize the retention of periosteum and intramedullary blood circulation.Limb lengthening more than 4 cm is recommended by leg Achilles tendon elastic synchronous lengthening fixator with calcaneal wire fixation.Following the principle of tension-stress,the lengthening is carried out slowly.Further,the lengthening device is removed step by step according to the principle of dynamic adjustment of fixed stiffness.

关 键 词：ILIZAROV技术 小腿延长术 肢体延长术 截骨术 胫骨平台 外固定架 活体组织 组织再生 

分 类 号：R687.3[医药卫生—骨科学]