股骨牵拉延长术治疗新生儿化脓性关节炎后严重短肢畸形

摘要

A procedure for leg length discrepancy beyond 5.0 cm following acute purulent arthritis of the hip is introduced.Four cases aged 7-13 years with Choi's type ⅣB septic sequelae manifestated destruction of the femoral head and neck,dislocation or subluxation of the hip;and leg length discrepancy.All of them associated with multiple joint damage.The leg length discrepancy ranging 6.9-14.0 cm was measured with graphic scan.Continuous traction with external fixation was used(Ilizarov apparatus 3;Orthofix system 1).The lengthening of the involved femurs was 4.5-13.0 cm with an average.follow-up of 3 years.3 of the patients could ambulate independantly without any brace.The authors suggest physical therapy(PT)be emphasized during traction,the traction should be suspended as soon as movements of the knee decrease,and reuse after intensive PT.The effect of this method is satisfactory.%介绍一种治疗急性化脓性髋关节炎后合并下肢不等长超过5.0 cm患儿的方法.本组共治疗4例蔡氏ⅣB型新生儿急性化脓性髋关节炎后遗症患儿,年龄7～13岁,临床症状有股骨头、颈的完全破坏,髋关节全或半脱位及双下肢不等长.术前均并发下肢其他关节化脓性炎症,术前用扫描图像法测量双下肢长度相差6.9～14.0 cm.采用外固定骨痂牵拉延长术治疗,3例外固定架为Ilizarov环形架,1例为Orthofix单侧架,牵拉后延长股骨4.5～13.0cm.术后随访2.5～3.5年,其中3例可以不用支具独立行走.该方法疗效满意,牵拉治疗中应重视关节功能练习,一旦膝关节功能减退,则暂停一段时间,加强功能练习后再进行牵拉.