应用Ilizarov技术治疗创伤后下肢短缩伴马蹄内翻足  

Application of the Ilizarov technique in the treatment of post-traumatic lower extremity shortening with talipes equinovarus

作　　者：徐明亮 陈国梁 董长红 彭爱民[2] 石荣剑 伊力扎提·伊力哈木 Xu Mingliang;Chen Guoliang;Dong Changhong;Peng Aimin;Shi Rongjian;Yilizati·Yilihamu(Department of Orthopaedics,Xuzhou Renci Hospital,Xuzhou 221004,China;Beijing Rehabilitation Hospital Affiliated to Capital Medical University,Beijing 100041,China)

机构地区：[1]徐州仁慈医院骨科,徐州221004 [2]北京骨外固定技术研究所,北京100041

出　　处：《中华整形外科杂志》2023年第3期285-292,共8页Chinese Journal of Plastic Surgery

基　　金：徐州市卫生健康委科技项目(XWKYHT20200022)。

摘　　要：目的:探讨应用Ilizarov技术治疗创伤后下肢短缩伴马蹄内翻足的临床效果。方法:回顾性分析2013年1月至2020年4月徐州仁慈医院骨科应用Ilizarov技术治疗的创伤后下肢短缩伴马蹄内翻足患者的临床资料。依据Ilizarov外固定穿针原则于患肢安装环形外固定架。术后3 d,以2 mm/d的速度调节足内、外侧螺纹杆,逐渐矫正马蹄内翻足;术后7 d,以1 mm/d的速度行小腿延长;马蹄内翻足矫正,继续佩戴外固定架维持4~6周,然后拆除足部固定架,配置足部支具固定6~8周;下肢长度恢复、延长处矿化良好后拆除小腿固定架。将术前及末次随访时记录的双下肢长度、距跟角度、踝关节跖屈和背伸角度、踝关节活动度进行对比;末次随访时用国际马蹄足畸形研究会(ICFSG)评分系统对患足进行评分和评级,分为优、良、中、差4级。应用SPSS 25.0软件进行统计分析,各测量指标数据及ICFSG评分以±s表示,术前与术后末次随访数据比较采用配对t检验,P<0.05为差异有统计学意义。结果:共纳入31例患者,其中男17例,女14例;年龄15~18岁,平均16.5岁;右侧16例,左侧15例;下肢短缩45~75 mm,平均65 mm。术后外固定架固定时间为4.5~6个月,平均5个月,随访时间为22~28个月,平均25.5个月,患侧下肢长度恢复,外形基本满意,恢复跖行步态。末次随访时与术前比较,患者足部前后跟距角(23.0°±2.1°vs.8.5°±2.6°)、外侧距跟角(27.0°±4.3°vs.11.2°±4.4°)、踝关节跖屈角度(24.5°±6.8°vs.51.1°±6.5°)、踝关节背伸角度(5.8°±3.5°vs.-46.8°±7.0°)、踝关节活动度(30.3°±8.2°vs.4.2°±1.6°)差异均有统计学意义(P均<0.01);ICFSG评分:末次随访时[(8.0±4.2)分]明显低于术前[(41.9±5.3)分](P<0.01),其中18例为优,9例为良,4例为中。2例后期出现畸形复发,二期行距舟关节和跟骰关节融合、胫后肌腱前置术后,效果满意;4例出现足趾挛缩畸形,在足趾处行趾长屈肌腱松解后Objective To investigate the effect of the Ilizarov technique in the treatment of post-traumatic lower extremity shortening with talipes equinovarus.Methods Clinical data of patients with post-traumatic lower extremity shortening and talipes equinovarus treated by the Ilizarov technique in the Department of Orthopaedics of Xuzhou Renci Hospital from January 2013 to April 2020 were retrospectively analyzed.The annular external fixator was installed on the affected limb according to the Ilizarov principle of external fixation.3 days after the operation,the internal and lateral screw rods were adjusted at the speed of 2 mm/d to gradually correct the talipes equinovarus.7 days after surgery,the lower leg was lengthened at a speed of 1 mm/d.After the foot was corrected,the foot external fixator was continued to be worn for 4 to 6 weeks,and then the fixator was removed and the foot was immobilized with a brace for 6 to 8 weeks.The lower leg fixator was removed after the lower extremity length was restored and the bone mineralization at the extension site was good.The length of both lower extremities,angle of talonavicular joint,angle of plantar flexion and dorsal extension of the ankle,and range of motion of ankle were compared before surgery and at the last follow-up.At the last follow-up,the affected feet were scored and rated using the International Clubfoot Study Group(ICFSG)scoring system,which was divided into four grades:excellent,good,medium,and poor.SPSS 25.0 software was used for statistical analysis,and each measurement index and ICFSG score were expressed in Mean±SD.Paired t-test was used to compare the preoperative and last follow-up data,and P<0.05 was considered statistically significant.Results A total of 31 patients were enrolled,including 17 males and 14 females.The age was 15-18 years old,with an average of 16.5 years old.There were 16 cases on the right side and 15 cases on the left side.The lower extremity shortening was 45-75 mm,with an average of 65 mm.The fixation time of the external fixator w

关 键 词：伊利扎罗夫技术 下肢短缩 马蹄足畸形 创伤 

分 类 号：R658.3[医药卫生—外科学]