Ilizarov技术治疗软骨发育不全下肢畸形早期临床研究  

Preliminary study of Ilizarov technique in treatment of lower limb deformity caused by achondroplasia

作　　者：郑学建 秦泗河 石磊 郭保逢 赵俊 殷海阳 ZHENG Xuejian;QIN Sihe;SHI Lei;GUO Baofeng;ZHAO Jun;YIN Haiyang(Department of Orthopedic Surgery,Rehabilitation Hospital Affiliated to National Research Center for Rehabilitation AIDS,Beijing,100176,P.R.China;Department of Orthopedics,Chuiyangliu 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》2023年第2期157-161,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨应用Ilizarov技术治疗软骨发育不全下肢畸形的手术方法及早期临床疗效。方法 回顾分析2014年2月—2021年9月应用Ilizarov技术治疗的38例软骨发育不全双下肢畸形患者临床资料。男18例,女20例;年龄7~34岁,平均14.8岁。均表现为双膝内翻、小腿内旋畸形。术前测量膝内翻角度为(15.2±4.2)°,膝关节学会评分系统(KSS)评分为(61.8±7.2)分。其中9例患者行胫腓骨截骨矫形,29例行胫腓骨截骨矫形并延长。术前及末次随访时摄站立位双下肢全长X线片,测量膝内翻角度,分析愈合指数,并记录并发症发生情况;通过KSS评分评估手术前后膝关节功能改善状况。结果 38例均获随访,随访时间9~65个月,平均26.3个月。术后4例发生针道感染、2例出现针道松动,经换药、更换克氏针及口服抗生素等对症处理后均好转;所有患者均未出现神经血管损伤。术后外固定架佩戴3~11个月,平均7.6个月;愈合指数43~59 d/cm,平均50.3 d/cm。末次随访时,小腿延长3~10 cm,平均5.5 cm。膝内翻角度为(1.5±0.2)°,KSS评分为(93.7±2.6)分,均较术前显著改善(P<0.05)。结论 采用Ilizarov技术治疗软骨发育不全所致短肢伴膝内翻畸形,可以改善患者生活质量,是一种安全有效的方法。Objective To investigate the surgical method and preliminary effectiveness of Ilizarov technique in the treatment of lower limb deformity caused by achondroplasia. Methods The clinical data of 38 patients with lower limb deformity caused by achondroplasia treated by Ilizarov technique between February 2014 and September 2021 were retrospectively analyzed. There were 18 males and 20 females, the age ranged from 7 to 34 years, with an average of 14.8years. All patients presented with bilateral knee varus deformity. The preoperative varus angles was(15.2±4.2)°, and knee society score(KSS) was 61.8±7.2. Nine of these patients underwent tibia and fibula osteotomy, 29 cases underwent tibia and fibula osteotomy and bone lengthening at the same time. Full-length bearing position X-ray films of bilateral lower limbs were taken to measure the bilateral varus angles, analyze the healing index, and record the occurrence of complications. KSS score was used to evaluate the improvement of knee joint function before and after operation.Results All 38 cases were followed up 9-65 months, with an average of 26.3 months. Needle tract infection occurred in4 cases and needle tract loosening occurred in 2 cases after operation, which were improved after symptomatic treatment such as dressing change, Kirschner wire change, and oral antibiotics, and no neurovascular injury occurred in all patients.The external fixator was worn for 3-11 months after operation, with an average of 7.6 months, and the healing index was43-59 d/cm, with an average of 50.3 d/cm. At last follow-up, the leg was 3-10 cm longer, with an average of 5.5 cm. The varus angles was(1.5±0.2)° and the KSS score was 93.7±2.6, which significantly improved when compared with those before operation(P<0.05). Conclusion Ilizarov technique is a safe and effective method for the treatment of short limb with genu varus deformity caused by achondroplasia, which can improve the quality of life of patients.

关 键 词：ILIZAROV技术 软骨发育不全 下肢畸形 截骨矫形 肢体延长 

分 类 号：R687.3[医药卫生—骨科学]