微创闭合截骨Ilizarov外固定延长技术治疗复杂小腿畸形疗效分析

摘要

目的 探讨Ilizarov外固定技术结合微创闭合截骨、缓慢牵伸延长矫治复杂小腿畸形的临床疗效.方法 2006年6月至2016年2月我科应用微创闭合截骨结合Ilizarov张力-应力法则及组织牵伸技术治疗83例下肢小腿复杂畸形.其中创伤骨缺损而致下肢短缩畸形的39例,由炎症感染性骨不连骨缺损而致下肢短缩畸形的36例,先天性假关节形成而导致下肢短缩畸形者8例;骨缺损长度为6～11 cm,平均8 cm.采用病灶微创闭合骨段切除、Ilizarov技术骨段延长治疗.参照Paley评价标准进行功能评价,并分析其骨折愈合时间、带外固定架时间、术后患肢功能恢复情况.结果 83例随访8个月至3年,平均16个月,畸形、负重力线获得完全或大部分矫正,步态及负重功能也基本恢复满意.带外固定架时间6 ～18个月,平均10.3个月;骨段搬移延长4.5 ～9.0 cm,平均6.3 cm;骨折愈合时间6～ 15个月,平均9.8个月.根据Paley骨折愈合及功能进行分级评价,优53例,良24例,可6例.结论 采用闭合微创截骨、针对性地软组织松解、缓慢牵拉成骨Ilizarov技术对小腿胫腓骨复杂畸形进行个体化治疗可以最大程度矫正畸形,是治疗小腿复杂畸形的可靠方法.%Objective To explore the clinical effects of Ilizarov technology combined with closed minimally invasive osteotomy and slow tissue distraction in the treatment of complex crus malformations.Methods From June 2006 to February 2016,83 cases suffering complex crus malformations in our department were treated by Ilizarov technique combined with closed minimally invasive osteotomy and slow tissue distraction.Of whom,39 cases were traumatic bone defect,36 cases were bone osteomyelitis,8 cases were congenital pseudarthrosis of tibia.Bone defect ranged from 6 to 11 cm,with an average of 8 cm.All cases were conducted by segmental resection of bone lesions combined with closed minimally invasive osteotomy and Ilizarov technique.The functional evaluation was carried out according to the Paley evaluation criterion.Bone healing time,duration of external fixation,postoperative limb lengthening and limb function recovery were recorded.Results Eighty-three patients were followed up for 8 to 36 months,with an average of 16 months.All patients' crus malformations were completely corrected.The external fixation time was from 6 to 18 months,with an average of 10.3 months;the length of the limb lengthening was from 4.5 to 9 cm,with an average of 6.3 cm;and bone healing time was from 6 to 15 months,with an average of 9.8 months.According to the Paley evaluation criterion,53 cases were excellent,24 cases were good,6 cases were general.Conclusion Ilizarov technology combined with closed minimally invasive osteotomy and slow tissue distraction a reliable method to correct the complex deformity of the tibia and fibula.