Taylor空间支架在儿童下肢畸形矫正中的应用  

Correction of lower limb deformities in children using Taylor spatial frame

作　　者：王士奇 王一臣[1] 应灏[1] 焦勤[1] 王隼[1] 马琪超 赵利华[1] Wang Shiqi;Wang Yichen;Ying Hao;Jiao Qin;Wang Sun;Ma Qichao;Zhao Lihua(Department of Orthopedics,Affiliated Municipal Children's Hospital,Shanghai Jiao Tong University,Shanghai)

机构地区：[1]上海市儿童医院,上海交通大学附属上海市儿童医院骨科,上海市200062

出　　处：《临床小儿外科杂志》2021年第9期837-842,共6页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金青年项目(编号:81401763);上海市自然科学基金面上项目(编号:20ZR1446600);上海交通大学医工交叉基金青年项目(编号:YG2021QN115)。

摘　　要：目的探讨Taylor空间支架(Taylor spatial frame,TSF)矫正儿童下肢畸形的临床疗效和精准度。方法2016年12月至2018年12月上海市儿童医院采用TSF矫治儿童下肢畸形5例,其中女4例,男1例;年龄4~15岁,平均8.2岁;特发性膝外翻及肢体短缩畸形1例,神经源性马蹄内翻足畸形1例,创伤后膝内翻及肢体短缩畸形1例,创伤后踝关节外翻及肢体短缩畸形1例,感染性膝外翻及肢体短缩畸形1例。术前常规拍摄标准双下肢全长或标准踝关节正位X线片,根据影像学资料全面评估双下肢或足踝的短缩、成角、旋转、移位情况,设计矫治方案及截骨平面。术中根据截骨平面按照穿针要求安装固定Taylor环,参考环垂直骨平面,安装TSF并测量支架的安装参数后,依据所定位截骨平面进行截骨。术后1周复查,拍摄标准的正侧位X线片以及大体照片,测量畸形参数,电脑软件系统中输入畸形参数和安装参数获得畸形矫正处方,依据新生成的电子矫正处方调整6个可伸缩连接杆,畸形矫治过程中每周复查X线片及外观照片,根据处方提示,必要时更换需要调整的连接杆直至畸形完全矫正。结果经过35~42 d的调节,2例经过1次处方畸形完全矫正,3例因残存畸形或过度矫治,经第二次或第三次2~6 d处方满意矫正畸形。截骨处新骨生成和矿化良好,术后1.5~6个月去除外固定架。随访时间6~29个月,畸形无复发。所有患者患肢关节功能恢复良好,畸形得到纠正。术后1例发生针道切割和感染,应用敏感抗生素及局部换药治疗痊愈。无一例血管神经损伤、继发马蹄足畸形、关节僵硬及去除外固定后再发骨折发生。结论Taylor空间支架矫正特发性、神经源性、外伤性及感染性畸形疗效确切,术后功能及外观恢复良好,精确度高,是儿童下肢畸形矫治的有效方法。Objective To evaluate the clinical outcomes and correction accuracy of lower limb deformities in children using Taylor spatial frame(TSF).Methods From December 2016 to December 2018,5 patients with lower limb deformities were treated with TSF.There were 1 boy and 4 girls with an average age of 8.2 years.There were idiopathic varus knee&lower limb deficiency(LLD,n=1),neurogenic clubfoot(n=1),posttraumatic varus knee&LLD(n=1),posttraumatic valgus ankle&LLD(n=1)and infective valgus knee and LLD(n=1).The preoperative full-length standing anterioposterior and lateral view films of ankle were taken.LLD,angulation,rotation and translation of deformity were evaluated and osteotomy levels designed accordingly.During operation,TSF was firstly mounted and reference ring perpendicular to reference bone.The mounting parameters were recorded followed by less invasive percutaneous osteotomy.The 6 struts were mounted according to the instruction after osteotomy was completely.Correction was started 7-10 days through adjusting the postoperative length of 6 struts following the time schedule generated by computer according to the mounting and deformity parameters.Radiographs were taken weekly during deformity correction.The struts were replaced when necessary.Results After frame adjusting for 35-42 days,2 cases of deformities were fully corrected.Three cases of residual slight angulation or crispation deformity were fully corrected after a second/third 2-6 days frame adjusting.New bone formation and consolidation at osteotomy site were excellent.The fixators were removed at Month 1.5-6.0 post-operation.During a follow-up period of 6-29 months,there was no recurrence of deformity.One case of pin site infection was controlled by using sensitive antibiotics and alginate dressing.There was no onset of vascular and nerve injury,secondary clubfoot,ankylosis or refracture.Conclusion Idiopathic,neurogenic,posttraumatic and infective deformities may be effectively corrected by TSF with a high accuracy.TSF is ideal for correcting complicate

关 键 词：下肢畸形 先天性/外科学 支架(骨科) 矫形外科器材 治疗结果 

分 类 号：R726.826[医药卫生—儿科] R726.8[医药卫生—临床医学]