1012例脊柱裂继发下肢畸形患者特点初步分析(秦泗河矫形外科数据库1986年10月12日—2020年12月31日)

Preliminary analysis of the clinical characteristics of 1 012 patients with secondary lower limb deformity of spina bifida from QIN Sihe Orthopedic Surgery Case Data between October 12, 1986 and December 31, 2020

目的基于秦泗河矫形外科数据库中脊柱裂继发下肢畸形患者临床资料,总结该类患者特点,为临床研究与诊治提供参考。方法回顾分析秦泗河矫形外科数据库中1986年10月12日—2020年12月31日接受矫形手术的1 012例脊柱裂继发下肢畸形患者临床资料,其中曾在外院接受下肢畸形矫形手术者231例(22.83%)。对患者人口学资料(性别、手术时年龄)、脊柱裂疾病相关指标(下肢畸形侧别、合并症、感觉障碍平面),以及手术相关信息(接受手术时间、手术部位、手术后固定方式)进行统计分析。结果 1 012例患者中,男457例、女555例。手术时年龄3~51岁,中位年龄18.0岁;其中15~30岁年龄段患者最多,占53.16%。畸形大多累及双侧下肢(652例,64.43%)。合并症:足负重区溃疡111例,大小便障碍265例,感觉障碍554例,腰部异常毛发85例。感觉障碍平面大多位于足踝部。2010年—2019年手术患者明显多于2010年之前,达总患者数的61.17%。手术治疗1 149个部位,其中足踝关节畸形手术矫正最多,占84.33%。矫形术后主要采用Ilizarov外固定(442例)、组合式外固定(315例)以及石膏固定(189例)。结论脊柱裂可继发严重下肢畸形且以足踝部为主,常见合并症包括负重区溃疡、大小便功能障碍及感觉障碍;矫形手术后固定方式以外固定为主。

Objective To analyze the characteristics of patients with secondary lower limb deformity of spina bifida based on the QIN Sihe Orthopedic Surgery Case Data, and provide the references for clinical research, diagnosis,and treatment. Methods A clinical data of 1 012 patients with secondary lower limb deformity of spina bifida between October 12, 1986 and December 31, 2020 selected from QIN Sihe Orthopedic Surgery Case Data was retrospectively analyzed. Among them, 231 cases(22.83%) had undergone orthopedic surgery for lower extremity deformities in other hospitals. The gender, age at surgery, indicators related to spina bifida(deformity side, comorbidity, sensory disturbance level), and information related to surgery(operating time, surgical site, postoperative fixation method) were analyzed.Results Of the 1 012 patients, 457 were males and 555 were females. The age was 3-51 years at the time of surgery, with a median of 18.0 years;among them, the 15-30 years old group had the most patients, accounting for 53.16%. Most deformities involved both lower limbs(652 cases, 64.43%). There were 111 cases of ulcers in the weight-bearing area of the foot, 265 cases of gatism, 554 cases of sensory disturbance, and 85 cases of abnormal hair on the waist. From 2010 to 2019,there were significantly more patients undergoing surgery than before 2010, reaching 61.17%. Sensory disturbances mostly occurred in the ankle and foot. A total of 1 149 sites were treated with surgery, of which the most ankle joint deformities were corrected by surgery, accounting for 84.33%. The main fixation methods after orthopedic surgery were external fixation, including Ilizarov external fixation(442 cases), combined external fixation(315 cases), and plaster fixation(189 cases). Conclusion Spina bifida can be secondary to severe deformities of the lower limbs, mainly in the ankles.Common complications include ulcers in the weight-bearing area, dysfunction of urine and feces, and sensory disturbances;external fixation is the main method of fixation after surgery.