摘要
背景:幼年期的股骨远端骨骺损伤,随年龄增长常出现不同程度的股骨短缩、膝关节内外翻和前弓等畸形,传统方法需多次手术治疗。目的:探讨应用Ilizarov技术治疗股骨短缩并膝关节畸形的手术方法和临床疗效。方法:回顾性分析2013年1月至2018年4月应用Ilizarov技术治疗的9例股骨远端骨骺损伤后遗股骨短缩并膝关节畸形患者的临床资料,男6例,女3例;年龄18~26岁,平均(22.1±2.9)岁;左侧2例,右侧7例;合并膝内、外翻5例,股骨髁上前弓4例。术中即时矫正膝关节内外翻及前弓畸形,然后在股骨中段斜形截骨,安装Ilizarov外固定器,术后逐渐调整外固定器,进行股骨延长及远端残留畸形的微调。随访复查双下肢全长正侧位X线片,观察下肢肢体长度、下肢力线、关节线及延长成骨情况,膝关节功能评分表(KSS)评价术后膝关节功能。结果:9例全部获得随访,随访时间为12~40个月,平均(20.5±7.6)个月。患者术后股骨短缩畸形和膝关节畸形均获得矫正。术后股骨延长3.0~7.5 cm,平均(4.1±0.9)cm;矫正膝关节内外翻畸形15°~25°,平均17.9°±2.8°;前弓畸形12°~20°,平均14.4°±2.4°。术后外固定器佩戴时间6~14个月,平均(9.3±2.6)个月。术后3例发生针道感染,换药处理后感染控制;1例针道松动,更换穿针位置,重新固定,均未出现神经血管损伤。末次随访膝关节KSS评分79~100分,平均(94.2±3.9)分。结论:Ilizarov技术治疗股骨远端骺损伤后遗股骨短缩合并膝关节畸形,能够准确恢复下肢长度和力线,手术创伤小、手术次数少、并发症少。
Background:The distal femoral epiphysis injury in the young stage often appears with the development of different degrees of femoral shortening,varus and valgus,flexion deformity of the knee joint.The traditional surgical treatment requires multiple operations.Objective:To investigate the surgical method and clinical effect of Ilizarov method in the treatment of femoral shortening and knee joint deformity simultaneously.Methods:Retrospective analysis was performed on 9 patients with femoral shortening and knee deformity due to distal femoral epiphysis injury treated with Ilizarov method from January 2013 to April2018,including 6 males and 3 females,with an average age of(22.1±2.9)years(range,18-26 years).There were 2 patients on the left side and 7 patients on the right side;5 patients with knee varus and valgus;4 patients with femoral condyle anterior arch.All patients were immediately corrected for most of the varus and valgus as well as anterior arch deformity of the knee during the operation.Then oblique osteotomy was performed in the middle segment of the femur and Ilizarov external fixator was installed.After the operation,the external fixator was gradually adjusted to realize femur lengthening and residual deformity correction.The full-length anteroposterior and lateral radiographs of the lower extremities were reexamined to observe the length,the alignment and the joint line of the lower extremities and the bone formation at extension part.The knee society keen score(KSS)was used to comprehensively evaluate the postoperative knee function.Results:All patients were followed up for 12-40 months with the mean of(20.5±7.6)months.Both femoral shortening and knee joint deformity were corrected at one stage.Postoperative femoral lengthening achieved 3.0 to 7.5 cm with the mean of(4.1±0.9)cm;the corrected knee joint deformity was 15°-25°with the mean of 17.9°±2.8°;corrected anterior arch deformity was 12°-20°with the mean of 14.4°±2.4°.The time of external fixation was 6-14 months,with the mean of(9.3±2.6)months.Three patients had pin infection and the infection was controlled after dressing change.In one patient,the pin was loosened and the pin position was changed and fixed again.There was no complications of neurovascular injury.The KSS score of knee joint at the last follow-up was 79-100 with the mean of(94.2±3.9).Conclusions:Ilizarov method can accurately restore the length and alignment of lower limbs,and has the advantages of mini invasive,fewer operation times and fewer complications in the treatment of femoral shortening and knee joint deformity.
作者
郑学建
秦泗河
郭保逢
石磊
赵俊
王执宇
ZHENG Xuejian;QIN Sihe;GUO Baofeng;SHI Lei;ZHAO Jun;WANG Zhiyu(Department of Orthopaedics,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 Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability,Beijing 100176;Department of Orthopaedics,Beijing Chui Yang Liu Hospital Affiliated to Tsinghua University,Beijing 100022,China)
出处
《中华骨与关节外科杂志》
2021年第6期480-484,共5页
Chinese Journal of Bone and Joint Surgery
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)
作者简介
通信作者:秦泗河,E-mail:qinsihe@163.com
