下肢延长术并发症的分类与治疗策略  

Complications of lower limb lengthening: classification and management

作　　者：臧建成 秦泗河 Zang Jiancheng;Qin Sihe(School of Population Medicine and Public Health,Bioethics research center,Chinese Academy of Medical Sciences/Peking Union Medical College,Beijing 100730,China;Rehabilitation Hospital of National Research Center for Rehabilitation Technical Aids,Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs,Beijing 100176,China)

机构地区：[1]中国医学科学院北京协和医学院群医学及公共卫生学院,生命伦理学研究中心,北京100730 [2]国家康复辅具研究中心附属康复医院矫形骨科,民政部康复辅具技术与系统重点实验室,北京100176

出　　处：《中华骨科杂志》2021年第11期728-736,共9页Chinese Journal of Orthopaedics

基　　金：民政部康复领域重点实验室及工程技术研究中心运行项目开放课题(120603020068);中国工程院咨询研究项目(2019-XZ-53-03/05)。

摘　　要：在下肢不等长矫形和侏儒症患者增高方面,下肢延长尤以股骨延长、胫骨延长技术最为常用和有效,但在临床上仍有一些并发症发生,某种程度上限制了这项技术的应用和发展。其原因可能与以下两点有关:①国内卫生和医学教育系统缺乏肢体延长亚学科建制,各大医院骨科极少有设立"肢体延长与重建"专科,学术与临床难以正确引领;②下肢延长与重建是个系统工程、整合学科,现代肢体延长技术具有自己的理论原则、医疗模式与医疗流程,不能完全应用经典骨科医疗范式指导。有学者将下肢延长的并发症按局部、全身,即刻、早期和晚期划分,或以感染和非感染分类,或按程度分为问题、障碍、并发症等,秦泗河提出将并发症按性质划分为软组织性、关节性、骨性、感染性和复合性五大类。这种分类方法能体现不同类型的特点,反应出层层递进的关系,便于记录、区分、强调和规避。下肢延长的不同时期可发生不同性质的并发症,不同性质的并发症可单独发生,也可以同时发生,不同程度的并发症亦可相互转化,互为因果。这就要求任何从事肢体延长的手术医生必须有坚实的矫形外科基础,能快速识别和有效处理各种并发症;下肢延长过程中患者应充分理解和执行整个医疗流程风险管控的每个环节要点,共同规避和减少并发症的发生。Lower limb lengthening,especially femur lengthening and tibia lengthening,is the most commonly used and effective technique in management of limb length discrepancy and dwarfism.However,there are many complications and sequelae in clinic practice,which limits the application and development of this technique to some extent.The reasons may be related to the following two points:one is the lack of sub discipline of limb lengthening in the domestic system of health and medical education,in other word,it is difficult acquired academic and clinical guidance from specialty of"Limb Lengthening and Reconstruction"in orthopedics departments and hospitals.Secondly,limb lengthening and reconstruction with its own theoretical principles and medical model is a systematic engineering and integration discipline,which cannot be completely guided by the classical orthopedic medical paradigm.The complications of lower limb lengthening have been classified according to local and general,immediate,early and late stage,or by infection and non-infection,or by problems,obstacles,complications,etc.Regarding the nature,Qin proposed a new classification for complications,which is divided into five categories:from soft tissue,from joint,from bone,infective and complex.This classification method can reflect the characteristics of different types,reflect the progressive relationship,and is easy to record,distinguish,emphasize and avoid.Different types of complications can occur in different stages of lower limb lengthening,different kinds of complications can occur alone or simultaneous,and different degrees of complications can transform into each other.It requires that surgeon engaged in limb lengthening must have solid knowledge of orthopedics,and be able to quickly identify and effectively deal with various complications;the patients should fully understand and implement the key points of each step during the whole process of limb lengthening,doctors and patients should be friends to avoid and reduce the occurrence of complications.

关 键 词：医疗流程 下肢不等长 肢体延长 矫形外科 侏儒症 医疗模式 股骨延长 学科建制 

分 类 号：R687.3[医药卫生—骨科学]