Ilizarov技术治疗手指短缩畸形  

Application of Ilizarov technique for the treatment of finger shortening deformity

作　　者：崔宜栋 臧建成 王刚[1] 孙玉亮 许庆家[1] 朱磊[1] CUI Yidong;ZANG Jiancheng;WANG Gang;SUN Yuliang;XU Qingjia;ZHU Lei(Department of Orthopaedics,Qilu Hospital,Shandong University,Jinan 250012;Department of Hand and Foot Surgery,Beijing University of Chinese Medicine Third Affiliated Hospital,Beijing 100029;Engineering Research Center of Chinese Orthopaedic and Sports Rehabilitation Artificial Intelligent,Ministry of Education,Beijing 100029;Qinsihe Orthopaedics Institute,Beijing 101199,China)

机构地区：[1]山东大学齐鲁医院骨科,济南250012 [2]北京中医药大学第三附属医院手足外科,北京100029 [3]“中医骨伤治疗与运动康复智能化”教育部工程研究中心,北京100029 [4]秦泗河矫形医学研究院,北京101199

出　　处：《中华骨与关节外科杂志》2023年第9期822-827,共6页Chinese Journal of Bone and Joint Surgery

基　　金：山东大学横向课题(26010112002034)。

摘　　要：目的:探讨Ilizarov技术治疗手指短缩畸形的临床效果。方法:2017年1月至2022年1月,采用Ilizarov骨延长技术治疗10例手指短缩患者,男9例,女l例;左侧4例,右侧6例;年龄18~55岁,平均31岁;外伤性手指短缩畸形7例,发育性手指短缩畸形3例;拇指7例,示指1例,中指2例。7例外伤性手指短缩畸形为机器挤压致手指离断,行短缩再植手术;3例发育性拇指短缩畸形为拇指多指畸形,患者幼儿期行多指切除术,逐渐出现短缩畸形。10例患者均采用单边轨道外固定器,术后第7日开始逐渐延长,每日延长0.5 mm,分3次完成。根据《中华医学会手外科学会上肢部分评定试用标准》评估手指再造功能。结果:10例患者均获得随访,随访时间8~16个月,平均11.8个月。所有患者指骨均骨性愈合,不需要植骨。骨延长时间25~65 d,平均41.5 d;骨延长长度1.0~2.2 cm,平均1.6 cm;指骨固定时间为90~210 d,平均163 d。手指功能评价:优5例,良4例,可1例,优良率90.0%(9/10)。两点辨别觉4~11 mm。患者对手指的外观和功能均表示满意。结论:采用Ilizarov技术行指骨延长,手术损伤小,避免供区损伤,能够改善手指的外观及功能,是治疗手指短缩畸形的一种有效方法。Objective:To investigate the clinical effect of Ilizarov technique in the treatment of finger shortening deformity.Methods:From January 2017 to January 2022,Ilizarov technique was used to treat finger shortening deformity in 10 patents.There were 9 males and 1 female,including 4 left hands and 6 right hands.The age ranged from 18 to 55 years,with an average of 31 years.There were 7 cases of finger shortening deformity after hand trauma and 3 cases of developmental finger shortening deformity.The thumb was involved in 7 patients,index finger in 1 patient and middle finger in 2 patients.Seven patients suffered from severed finger injury caused by machine crush and underwent replantation surgery.Three patients gradually appeared thumb shortening because they suffered multiple finger resection in their childhood.All the patients underwent the bone lengthening with mini-track extension fixation.After a 7-day latent period,gradual distraction began at a rate of 0.5 mm per day,3 times a day.The finger function was evaluated by the trial evaluation standard of upper limb reconstruction of the Chinese Medical Association of Hand Surgery.Results:All the patients were followed up for an average of 11.8 months(range,8-16 months).Bony union achieved in all the patients without bone grafts.The incisions healed without infection.The average bone lengthening time was 41.5 d(range,25-65 d),and the average lengthening length was 1.6 cm(range,1.0-2.2 cm).The average fixation time of digits was 163 d(range,90-210 d).The result of digit function assessment was as follows:5 cases were excellent,4 cases were good,1 case was fair,and the excellent and good rate was 90.0%(9/10).Two point discrimination sense was 4-11 mm.The patient was satisfied with the function and appearance of the digits.Conclusions:Distraction lengthening of the digits with Ilizarov technique can avoid bone grafts and improve the hand esthetic and function,has less invasion,and is an effective method for the treatment of finger shortening deformity.

关 键 词：ILIZAROV技术 手指 短缩畸形 骨延长 外固定器 

分 类 号：R687[医药卫生—骨科学]